Healthcare Provider Details

I. General information

NPI: 1083171326
Provider Name (Legal Business Name): JASON EDWARD WATTS PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 STONEFOREST DR STE 230
WOODSTOCK GA
30189-4903
US

IV. Provider business mailing address

100 STONEFOREST DR STE 230
WOODSTOCK GA
30189-4903
US

V. Phone/Fax

Practice location:
  • Phone: 470-552-8470
  • Fax: 470-437-3924
Mailing address:
  • Phone: 470-552-8470
  • Fax: 470-437-3924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN-NP219889
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN219889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: