Provider Demographics
NPI:1538390877
Name:WATTS, DAVID LEON (BS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:LEON
Last Name:WATTS
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HALLS
Mailing Address - State:TN
Mailing Address - Zip Code:38040-1523
Mailing Address - Country:US
Mailing Address - Phone:731-836-7211
Mailing Address - Fax:731-836-0344
Practice Address - Street 1:112 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HALLS
Practice Address - State:TN
Practice Address - Zip Code:38040-1523
Practice Address - Country:US
Practice Address - Phone:731-836-7211
Practice Address - Fax:731-836-0344
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist