Healthcare Provider Details

I. General information

NPI: 1104759000
Provider Name (Legal Business Name): ERIC ANTHONY WATSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W 4TH ST STE 324
CHARLOTTE NC
28202-1545
US

IV. Provider business mailing address

227 W 4TH ST STE 324
CHARLOTTE NC
28202-1545
US

V. Phone/Fax

Practice location:
  • Phone: 704-816-0380
  • Fax:
Mailing address:
  • Phone: 704-816-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: