MEDICARE: JAMES A. WATKINS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	24954	NC
2	208600000X	Surgery Physician	24954	NC
3	208D00000X	General Practice Physician	24954	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	171JK	OTHER	NC	BCBSNC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023009321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES A. WATKINS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 470255
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28247-0255
Country	:	US
Telephone Number	:	704-512-5360
Fax Number	:	704-512-5080

Provider Business Practice Location Address
First Line	:	1601 ABBEY PL
Second Line	:	STE. 105
City	:	CHARLOTTE
State	:	NC
Zip	:	28209-3835
Country	:	US
Telephone Number	:	704-512-5360
Fax Number	:	704-512-5080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	10/23/2018

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