Healthcare Provider Details

I. General information

NPI: 1023546645
Provider Name (Legal Business Name): WATT HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2017
Last Update Date: 05/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 KNIGHT RD
MEMPHIS TN
38118-5104
US

IV. Provider business mailing address

4728 SPOTTSWOOD AVE # 106
MEMPHIS TN
38117-4817
US

V. Phone/Fax

Practice location:
  • Phone: 770-354-9827
  • Fax:
Mailing address:
  • Phone: 770-354-9827
  • Fax: 901-531-8054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: TOLYSA JONES
Title or Position: PRESIDENT
Credential:
Phone: 770-354-9827