Healthcare Provider Details

I. General information

NPI: 1477118750
Provider Name (Legal Business Name): JULIANNA MARIE WATKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9121 ANSON WAY STE 200
RALEIGH NC
27615-5857
US

IV. Provider business mailing address

9121 ANSON WAY STE 200
RALEIGH NC
27615-5857
US

V. Phone/Fax

Practice location:
  • Phone: 910-719-3315
  • Fax: 919-373-3083
Mailing address:
  • Phone: 910-719-3315
  • Fax: 919-373-3083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: