Provider Demographics
NPI:1932129053
Name:WATTS, TERESSA MCKOY (MD)
Entity Type:Individual
Prefix:
First Name:TERESSA
Middle Name:MCKOY
Last Name:WATTS
Suffix:
Gender:F
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:PO BOX 601067
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1067
Mailing Address - Country:US
Mailing Address - Phone:704-801-3050
Mailing Address - Fax:704-801-3026
Practice Address - Street 1:9908 COULOAK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28216-8678
Practice Address - Country:US
Practice Address - Phone:704-801-3050
Practice Address - Fax:704-801-3026
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1003COtherNCBCBS
NC891003CMedicaid
NC1932129053Medicaid
NC1003COtherNCBCBS
NC891003CMedicaid
NC1932129053Medicaid