Healthcare Provider Details

I. General information

NPI: 1841126679
Provider Name (Legal Business Name): ADMAD RASHAD WATTERSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 THOR LANE
BLUEFIELD WV
24701
US

IV. Provider business mailing address

PO BOX 7028
PRINCETON WV
24740-0197
US

V. Phone/Fax

Practice location:
  • Phone: 304-809-5823
  • Fax:
Mailing address:
  • Phone: 304-809-5823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: