Healthcare Provider Details

I. General information

NPI: 1487882528
Provider Name (Legal Business Name): JONATHAN MICHAEL WATTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2009
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 HIGHWAY 126
BRISTOL TN
37620-3310
US

IV. Provider business mailing address

PO BOX 95460
CLEVELAND OH
44101-0033
US

V. Phone/Fax

Practice location:
  • Phone: 423-968-1144
  • Fax:
Mailing address:
  • Phone: 602-581-6076
  • Fax: 602-263-1619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number2010-00804
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2010-00804
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: