Provider Demographics
NPI:1649034646
Name:WATSON, JAMES (LMBT)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:WATSON
Suffix:
Gender:M
Credentials:LMBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 STAMPER RD STE 201
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4100
Mailing Address - Country:US
Mailing Address - Phone:910-818-2513
Mailing Address - Fax:910-401-1030
Practice Address - Street 1:806 STAMPER RD STE 201
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4100
Practice Address - Country:US
Practice Address - Phone:910-818-2513
Practice Address - Fax:910-401-1030
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20618225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist