Provider Demographics
NPI:1235905282
Name:WATSON, LOTHEL
Entity Type:Individual
Prefix:
First Name:LOTHEL
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:468 EDDLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:KANNAPOLIS
Mailing Address - State:NC
Mailing Address - Zip Code:28083-6117
Mailing Address - Country:US
Mailing Address - Phone:704-490-5511
Mailing Address - Fax:
Practice Address - Street 1:700 N CANNON BLVD STE 113
Practice Address - Street 2:
Practice Address - City:KANNAPOLIS
Practice Address - State:NC
Practice Address - Zip Code:28083-4078
Practice Address - Country:US
Practice Address - Phone:704-490-5511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-30
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist