Healthcare Provider Details

I. General information

NPI: 1104750652
Provider Name (Legal Business Name): CARLA V WATTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6545 BELLBURN RD
ATLANTA GA
30349-4611
US

IV. Provider business mailing address

6545 BELLBURN RD
ATLANTA GA
30349-4611
US

V. Phone/Fax

Practice location:
  • Phone: 404-492-3422
  • Fax: 404-492-3422
Mailing address:
  • Phone: 404-492-3422
  • Fax: 404-492-3422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License NumberCN0014182423
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: