MEDICARE: ERIC ANTHONY WATSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		NC

General Provider Information

NPI Number	:	1104759000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIC ANTHONY WATSON

Provider Business Mailing Address
First Line	:	227 W 4TH ST STE 324
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1545
Country	:	US
Telephone Number	:	704-816-0380
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 W 4TH ST STE 324
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28202-1545
Country	:	US
Telephone Number	:	704-816-0380
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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