Healthcare Provider Details

I. General information

NPI: 1801329149
Provider Name (Legal Business Name): JUSTIN T WATTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 12/18/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 5TH ST N
COLUMBUS MS
39705-2008
US

IV. Provider business mailing address

1509 6TH AVE S
BIRMINGHAM AL
35233-1601
US

V. Phone/Fax

Practice location:
  • Phone: 662-244-1584
  • Fax: 662-244-2086
Mailing address:
  • Phone: 205-930-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number29816
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: