Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 24954 | NC |
N | 208600000X | Surgeon | 24954 | NC |
Y | 208D00000X | General Practice Physician | 24954 | NC |
NPI | 1023009321 |
---|---|
Provider Name | James A. Watkins |
First Address | Charlotte, NC 28247-0255 |
Second Address | Charlotte, NC 28209-3835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 23/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
171JK | BCBSNC (01) | NC |
8985934 | (05) | NC |
C81286 | (02) |