Provider Demographics
NPI:1053921858
Name:ADEDEJI WATSON, KWESI (SLP)
Entity type:Individual
Prefix:DR
First Name:KWESI
Middle Name:
Last Name:ADEDEJI WATSON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1691 PHOENIX BLVD STE 395
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5511
Mailing Address - Country:US
Mailing Address - Phone:678-545-0272
Mailing Address - Fax:
Practice Address - Street 1:1691 PHOENIX BLVD STE 395
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-5511
Practice Address - Country:US
Practice Address - Phone:678-545-0272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009251235Z00000X
GA009251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist