Provider Demographics
NPI:1063438273
Name:WATTS, MARILYN P (MD)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:P
Last Name:WATTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 DELL GLADE DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38111-4716
Mailing Address - Country:US
Mailing Address - Phone:901-486-5246
Mailing Address - Fax:
Practice Address - Street 1:2900 KIRBY PKWY
Practice Address - Street 2:#1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119
Practice Address - Country:US
Practice Address - Phone:901-737-7393
Practice Address - Fax:901-737-2696
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN30757208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3836947Medicaid
TN3836947Medicare ID - Type Unspecified
TN3836947Medicaid