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NPI Code Detail

MEDICARE: JENNIFER A WATTS PH.D., LMFT

MEDICARE: JENNIFER A WATTS PH.D., LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFT-001075GA

General Provider Information

NPI Number : 1083050579
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER A WATTS PH.D., LMFT
Provider Business Mailing Address
First Line : 25 LENOX POINTE NE STE B
Second Line :
City : ATLANTA
State : GA
Zip : 30324-7420
Country : US
Telephone Number : 404-266-0962
Fax Number : 404-266-8687
Provider Business Practice Location Address
First Line : 25 LENOX POINTE NE STE B
Second Line :
City : ATLANTA
State : GA
Zip : 30324-7420
Country : US
Telephone Number : 404-266-0962
Fax Number : 404-266-8687
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2013
Last Update Date : 05/11/2013

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