Provider Demographics
NPI:1285739284
Name:WATTS, TIMOTHY DALE (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:DALE
Last Name:WATTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:321 W HILL ST STE 4
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-4362
Mailing Address - Country:US
Mailing Address - Phone:404-574-2360
Mailing Address - Fax:
Practice Address - Street 1:321 W HILL ST STE 4
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-4362
Practice Address - Country:US
Practice Address - Phone:404-574-2360
Practice Address - Fax:404-373-8060
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0311151207R00000X
GA031151207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE47901Medicare UPIN