Provider Demographics
NPI:1083171326
Name:WATTS, JASON EDWARD (PMHNP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:EDWARD
Last Name:WATTS
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STONEFOREST DR STE 230
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-4903
Mailing Address - Country:US
Mailing Address - Phone:470-552-8470
Mailing Address - Fax:470-437-3924
Practice Address - Street 1:100 STONEFOREST DR STE 230
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-4903
Practice Address - Country:US
Practice Address - Phone:470-552-8470
Practice Address - Fax:470-437-3924
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-22
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPRN-NP219889363LP0808X
GARN219889163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse