Healthcare Provider Details

I. General information

NPI: 1477548584
Provider Name (Legal Business Name): MICHAEL KENNETH WATTERSON MD, FACR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

IV. Provider business mailing address

1850 W ARLINGTON BLVD
GREENVILLE NC
27834-5704
US

V. Phone/Fax

Practice location:
  • Phone: 252-752-6101
  • Fax: 252-752-6600
Mailing address:
  • Phone: 252-752-6101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2021-01962
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: