Willie Mack Watts, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

10853 Issued in GA

Practice address

4292 Gray Hwy
Gray, GA 31032-5900

Phone

(478) 986-2500

Fax

(478) 864-1288

NPI assigned

Jul 12, 2007

Last updated

Jun 13, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Community Health Care Systems, Inc.

  dba Johnson County Center for Community Health

  • Federally Qualified Health Center (FQHC)
  • Wrightsville, GA
  • NPI 1932150422
  Medicare reassignment
• The Carolinas Emergency Group, PLLC

  • Emergency Medicine Physician
  • Dunn, NC
  • NPI 1477508836
  Medicare reassignment
• Community Health Care Systems Inc,

  dba Sandersville Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sandersville, GA
  • NPI 1861666455
  NPD
• Community Health Care Systems, Inc

  dba Community Health Care Systems Administration & Specialty Services

  • Federally Qualified Health Center (FQHC)
  • Sandersville, GA
  • NPI 1184515694
  NPD
• Riverview Emergency Physicians LLC

  • Emergency Medicine Physician
  • Gadsden, AL
  • NPI 1184822652
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655078400000",
    "number": "1679772388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73",
            "city": "PORT ROYAL",
            "state": "SC",
            "postal_code": "299350073",
            "telephone_number": "256-393-9663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4292 GRAY HWY",
            "city": "GRAY",
            "state": "GA",
            "postal_code": "310325900",
            "telephone_number": "478-986-2500",
            "fax_number": "478-864-1288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "WILLIE",
        "middle_name": "MACK",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-12",
        "last_updated": "2022-06-13",
        "certification_date": "2022-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10853",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AL",
            "license": "PA-184",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009911802",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• True Essential Transportation Service, LLC
• US Medics EMS Inc
• Walgreen Co (Walgreens #11940)
• Walgreen Co (Rite Aid #3254)
• Ralph Parks Warnock, M.D.
• West Clinton Family Dentistry, LLC
• Kayla Sue Whitley, DNP, APRN, FNP-C
• Michael Christopher Williamson, LMFT
• Catherine Marie Wilson, FNP
• Kimberlyn Jena Wilson, PT, DPT

• Physician Assistant in Gray, GA
• Providers in Gray, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.