Provider Demographics
NPI:1093785099
Name:WATKINS, WILLIAM S (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:WATKINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 ABERDEEN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-0606
Mailing Address - Country:US
Mailing Address - Phone:704-866-9200
Mailing Address - Fax:704-866-9824
Practice Address - Street 1:2450 ABERDEEN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-0606
Practice Address - Country:US
Practice Address - Phone:704-866-9200
Practice Address - Fax:704-866-9824
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32973174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985939Medicaid
NC8985939Medicaid
NCBW1643926OtherDEA
NC2160942BMedicare ID - Type Unspecified