Healthcare Provider Details

I. General information

NPI: 1609860303
Provider Name (Legal Business Name): JAMES C WATTS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 EAST MAIN STREET
MORRISTOWN TN
37814-6632
US

IV. Provider business mailing address

P.O. BOX 1718
MORRISTOWN TN
37816-1718
US

V. Phone/Fax

Practice location:
  • Phone: 423-581-5987
  • Fax: 423-581-0984
Mailing address:
  • Phone: 423-581-5987
  • Fax: 423-581-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number10769
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: