MEDICARE: MR. DANTEY MAURICE WATTS SURGICAL ASSISTANT

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	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1770742934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANTEY MAURICE WATTS SURGICAL ASSISTANT

Provider Business Mailing Address
First Line	:	4437 ESTATE ST
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-8846
Country	:	US
Telephone Number	:	770-695-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	4437 ESTATE STREET
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30349-1808
Country	:	US
Telephone Number	:	770-695-8444
Fax Number	:

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

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	04/18/2017

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