Basic Information
| Provider Information | |||||||||
| NPI: | 1225398811 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | J. MICHAEL WATTS | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MARSHALL NEUROLOGY CENTER | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1845 | ||||||||
| Address2: | |||||||||
| City: | ALBERTVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359500030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568783999 | ||||||||
| FaxNumber: | 2568783779 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 WALL ST | ||||||||
| Address2: | |||||||||
| City: | ALBERTVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 359517392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568783999 | ||||||||
| FaxNumber: | 2568783779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2012 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | WATTS | ||||||||
| AuthorizedOfficialFirstName: | JOHNNY | ||||||||
| AuthorizedOfficialMiddleName: | MICHAEL | ||||||||
| AuthorizedOfficialTitleorPosition: | NEUROLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 2568783999 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084S0012X | DO.449 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Sleep Medicine |
ID Information
| ID | Type | State | Issuer | Description | 130002 | 05 | AL | MEDICAID |