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General NPI Number Information
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NPI Number | 1336144138
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Entity Type | Individual
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Provider Name | JEROME THOMAS WATSON MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 293 OLD MOCKSVILLE ROAD
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City | STATESVILLE
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State | NC
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Zip | 28625-1903
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Country | US
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Telephone | 704-872-8711
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Fax | 704-872-5866
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Provider Business Mailing Address
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Address Line | 169 MONTIBELLO DR
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City | MOORESVILLE
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State | NC
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Zip | 28117-9149
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Country | US
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Telephone | 704-872-6840
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 9800413
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License Number State | NC
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