Provider Demographics
NPI:1730180183
Name:WATTS, CHARLES HUNTER (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HUNTER
Last Name:WATTS
Suffix:
Gender:M
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:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70073-2400
Mailing Address - Country:US
Mailing Address - Phone:504-391-7337
Mailing Address - Fax:504-398-7213
Practice Address - Street 1:4225 LAPALCO BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70073-2400
Practice Address - Country:US
Practice Address - Phone:504-391-7337
Practice Address - Fax:504-398-7213
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0137402080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300721Medicaid