Basic Information
| Provider Information | |||||||||
| NPI: | 1821261819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | PEARLIE | ||||||||
| MiddleName: | BRADFORD | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4402 SHIPYARD BLVD. | ||||||||
| Address2: | EASTERN CAROLINA EMERGENCY PHYSICIANS | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102023363 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4402 SHIPYARD BLVD. | ||||||||
| Address2: | EASTERN CAROLINA EMERGENCY PHYSICIANS | ||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9102023363 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/10/2008 | ||||||||
| LastUpdateDate: | 11/22/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2011-00899 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5917678 | 05 | NC | MEDICAID | 1821261819 | 01 | NC | CHAMPUS | OTHER | P01131867 | 01 | NC | RAILROAD MEDICARE | OTHER |