| Doctor Name: | WILLIE MACK WATTS |
| NPI Number: | 1679772388 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA |
| License Number: | PA-184 |
| Business Practice Address: | 1008 9th St Port Royal, SC - 299352315 |
| Business Phone Number: | 2563939663 |
| Business Fax Number: | |
| Mailing Address: | Po Box 73, PORT ROYAL |
| State: | SC |
| Postal Code: | 299350073 |
| Phone Number: | 2563939663 |
| Fax Number: | |
| NPI Enumeration Date: | 07/12/2007 |
| NPI Last Update Date: | 11/12/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA-184 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |