MEDICARE: EDNA R WATTS NP

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	363LF0000X	Family Nurse Practitioner	RN036579NP	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922006444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDNA R WATTS NP

Provider Business Mailing Address
First Line	:	PO BOX 189
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-0189
Country	:	US
Telephone Number	:	478-987-1261
Fax Number	:	478-218-0839

Provider Business Practice Location Address
First Line	:	1012 GA HIGHWAY 247 S
Second Line	:
City	:	KATHLEEN
State	:	GA
Zip	:	31047-2349
Country	:	US
Telephone Number	:	478-987-1261
Fax Number	:	478-218-0839

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/13/2011

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Directions to “ EDNA R WATTS NP” Practice Location

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