MEDICARE: CHAD EVAN WATTS PA-C

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
1	363A00000X	Physician Assistant		SC

General Provider Information

NPI Number	:	1164892063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHAD EVAN WATTS PA-C

Provider Business Mailing Address
First Line	:	2193 WEDGEWOOD DR
Second Line	:
City	:	LONGS
State	:	SC
Zip	:	29568-8882
Country	:	US
Telephone Number	:	910-640-8721
Fax Number	:

Provider Business Practice Location Address
First Line	:	1016 2ND AVE N STE 203F
Second Line	:
City	:	NORTH MYRTLE BEACH
State	:	SC
Zip	:	29582-3288
Country	:	US
Telephone Number	:	843-273-9000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2015
Last Update Date	:	08/12/2024

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