Healthcare Provider Details

I. General information

NPI: 1265643993
Provider Name (Legal Business Name): ADRIELYN MARIE WATTS RDMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 BROKEN SOUND PKWY NW SUITE 500
BOCA RATON FL
33487-2773
US

IV. Provider business mailing address

3055 BATTLE GREEN WAY
DECATUR GA
30034-3603
US

V. Phone/Fax

Practice location:
  • Phone: 561-367-1175
  • Fax:
Mailing address:
  • Phone: 770-639-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number113499
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: