Active NPI
Devon Watson, DMD
- Endodontics
- McDonough, GA
National Provider Identifier
1104268028
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN014637
- Practice address
- 1867 Jonesboro Rd Ste 6
McDonough, GA 30253-6099 - Phone
- (678) 432-0209
- NPI assigned
- Jul 19, 2013
- 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 |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN014637 | GA | Primary |
Addresses
Primary practice location
1867 Jonesboro Rd Ste 6
McDonough, GA 30253-6099
Mailing address
1867 Jonesboro Rd Ste 6
McDonough, GA 30253-6099
Phone (678) 432-0209
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN014637 | GA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Love Your Smile LLC | Dentist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Douglasville, GA
- NPI 1578001384
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1374192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1709683200000",
"number": "1104268028",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1867 JONESBORO RD STE 6",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536099",
"telephone_number": "678-432-0209"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1867 JONESBORO RD STE 6",
"city": "MCDONOUGH",
"state": "GA",
"postal_code": "302536099",
"telephone_number": "678-432-0209"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATSON",
"first_name": "DEVON",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-07-19",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "GA",
"license": "DN014637",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McDonough, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.