Healthcare Provider Details

I. General information

NPI: 1194308338
Provider Name (Legal Business Name): JULIA WATSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 HARRISON AVE
BOSTON MA
02111-1800
US

IV. Provider business mailing address

1200 N ELM ST
GREENSBORO NC
27401-1020
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-7272
  • Fax: 336-832-8641
Mailing address:
  • Phone: 336-832-7272
  • Fax: 336-832-8641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.156815
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2025-0011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: