Individual
PERRY TANIS WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MPA
Contact information
Practice address
6120 CARRIAGE OAKS DR, CHARLOTTE, NC 28262-3253
(704) 506-6888
(704) 378-0363
Mailing address
PO BOX 217125, CHARLOTTE, NC 28221-0125
(704) 506-6888
(704) 378-0363
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
MHL-081-074
NC
Other
Enumeration date
12/19/2007
Last updated
12/19/2007
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