Provider Demographics
NPI:1265787162
Name:JAMES WATKINS
Entity type:Organization
Organization Name:JAMES WATKINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-616-4062
Mailing Address - Street 1:PO BOX 470255
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247-0255
Mailing Address - Country:US
Mailing Address - Phone:704-335-5418
Mailing Address - Fax:704-314-0737
Practice Address - Street 1:1601 ABBEY PL
Practice Address - Street 2:STE 105
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-3835
Practice Address - Country:US
Practice Address - Phone:704-512-5360
Practice Address - Fax:704-512-5080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24954261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985934Medicaid
1023009321OtherINDIVIDUAL NPI #
171JKOtherBCBSNC
NC8985934Medicaid
NCNC71570281Medicare PIN