Healthcare Provider Details

I. General information

NPI: 1336379106
Provider Name (Legal Business Name): TRACY CAROLE WATSON ACSM-CEP, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACY CAROLE WATSON WANG PA-C

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MANNING DR MAIN HOSPITAL N 1181
CHAPEL HILL NC
27514-4220
US

IV. Provider business mailing address

101 MANNING DR MAIN HOSPITAL N 1181
CHAPEL HILL NC
27514-4220
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-5165
  • Fax:
Mailing address:
  • Phone: 919-966-5165
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-01893
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: