Provider Demographics
NPI:1861048092
Name:WATTS, TACHIANA COURNITA
Entity type:Individual
Prefix:
First Name:TACHIANA
Middle Name:COURNITA
Last Name:WATTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 AUTUMN LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-6590
Mailing Address - Country:US
Mailing Address - Phone:678-510-8961
Mailing Address - Fax:
Practice Address - Street 1:324 AUTUMN LAKE DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-6590
Practice Address - Country:US
Practice Address - Phone:678-510-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula