Provider Demographics
NPI:1952474769
Name:WATSON, ERIC JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JAMES
Last Name:WATSON
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 1:202 GAVIN ST
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477
Mailing Address - Country:US
Mailing Address - Phone:843-563-3512
Mailing Address - Fax:843-563-4464
Practice Address - Street 1:202 GAVIN ST
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477
Practice Address - Country:US
Practice Address - Phone:843-563-3512
Practice Address - Fax:843-563-4464
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13161207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC131618Medicaid
SC131618Medicaid
C61426Medicare UPIN