Kwesi Adedeji Watson, SLP
Individual provider Active NPI Speech-Language Pathologist · Atlanta, GA
NPI 1053921858 · NPPES record last updated Mar 3, 2021
Key facts
- NPI
- 1053921858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- 009251 (GA)
- Practice address
- 1691 Phoenix Blvd Ste 395
Atlanta, GA 30349-5511 - Phone
- (678) 545-0272
- NPI assigned
- Aug 6, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200820003715 | GA | Practitioner - Qualified Speech Language Pathologist | 8426474404 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SLP009251 | GA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Swallowing Doctor | Speech-Language Pathologist | Current |
Accepting new patients |
Locations
1691 Phoenix Blvd
Ste 395
Atlanta, GA 30349
Phone (678) 545-0272
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SLP009251 | GA | |
| Speech-Language Pathologist | 235Z00000X | 009251 | GA | Yes |
Addresses
Primary practice location
1691 Phoenix Blvd Ste 395
Atlanta, GA 30349-5511
Mailing address
1691 Phoenix Blvd Ste 395
Atlanta, GA 30349-5511
Phone (678) 545-0272
Other practice location 1
290 Highway 314 Ste B
Fayetteville, GA 30214-7813
Phone (404) 994-7727
Other providers in Atlanta, GA
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- Nimota A Adeboye
- Titilola Olaide Adeboye
- Adesola Bosede Adedapo Okoror
- Oluwatoyin Adedapo-Jimoh
- Bolanle Olubunmi Adedokun
- Adedamola Ayoola Adedoyin
- Oluwajimi David Adedoyin
- Adeel & Sana LLC
- Olujimi Ayodele Adefisan
All providers in Atlanta, GA · Speech-Language Pathologist in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.