Provider Demographics
NPI:1528776333
Name:WATTS, RODERICK J (PHD)
Entity type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:J
Last Name:WATTS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N HIGHLAND AVE NE STE 230-529
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1936
Mailing Address - Country:US
Mailing Address - Phone:404-994-1769
Mailing Address - Fax:
Practice Address - Street 1:114 BRUTON ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-3767
Practice Address - Country:US
Practice Address - Phone:404-994-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-10
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical