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General NPI Number Information
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NPI Number | 1164524005
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Entity Type | Individual
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Provider Name | STANLEY RUDOLPH WATSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 864 BLACK CREEK RD
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City | FOUR OAKS
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State | NC
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Zip | 27524-8314
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Country | US
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Telephone | 919-963-3148
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Fax | 919-963-2900
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Provider Business Mailing Address
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Address Line | PO BOX 96860
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City | CHARLOTTE
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State | NC
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Zip | 28296-6860
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Country | US
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Telephone | 919-359-1011
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Fax | 919-359-9122
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 38490
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License Number State | NC
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