Healthcare Provider Details

I. General information

NPI: 1396535035
Provider Name (Legal Business Name): HALEEM ABDEL WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 HOWELL MILL RD NW FL 8
ATLANTA GA
30318-5557
US

IV. Provider business mailing address

626 ENGLISH AVE NW
ATLANTA GA
30318-8458
US

V. Phone/Fax

Practice location:
  • Phone: 404-977-6910
  • Fax:
Mailing address:
  • Phone: 718-663-1680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: