Healthcare Provider Details

I. General information

NPI: 1619488293
Provider Name (Legal Business Name): ERIC MICHAEL WATTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 WINN WAY
DECATUR GA
30030-1707
US

IV. Provider business mailing address

270 CARPENTER DR NE SUITE 400
SANDY SPRINGS GA
30328
US

V. Phone/Fax

Practice location:
  • Phone: 404-508-7700
  • Fax:
Mailing address:
  • Phone: 678-460-0345
  • Fax: 678-460-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMSW007016
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: