MEDICARE: WILLIAM LYLE WATKINS MD

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	207R00000X	Internal Medicine Physician	9800412	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447243704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM LYLE WATKINS MD

Provider Business Mailing Address
First Line	:	PO BOX 344
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27102-0344
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-903-2908

Provider Business Practice Location Address
First Line	:	1916 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:	336-903-2908

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

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	10/07/2010

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