Active NPI
Marilyn P Watts, MD
- Pediatrics Physician
- Memphis, TN
National Provider Identifier
1063438273
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 30757
- Practice address
- 2900 Kirby Pkwy
#1
Memphis, TN 38119 - Phone
- (901) 737-7393
- Fax
- (901) 737-2696
- NPI assigned
- Jul 14, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 30757 | TN | Primary |
Addresses
Primary practice location
2900 Kirby Pkwy
#1
Memphis, TN 38119
Mailing address
3330 Dell Glade Dr
Memphis, TN 38111-4716
Phone (901) 486-5246
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3836947 | Medicaid | TN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30757 | TN | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152835200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247788800000",
"number": "1063438273",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3330 DELL GLADE DR",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381114716",
"telephone_number": "901-486-5246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 KIRBY PKWY",
"address_2": "#1",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "38119",
"telephone_number": "901-737-7393",
"fax_number": "901-737-2696"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTS",
"first_name": "MARILYN",
"middle_name": "P",
"name_prefix": "Mrs.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-14",
"last_updated": "2009-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TN",
"license": "30757",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3836947",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.