1780836742 NPI number — SYMAKLA WATSON INVESTMENTS CORPORATION

Table of content: (NPI 1780836742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780836742 NPI number — SYMAKLA WATSON INVESTMENTS CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SYMAKLA WATSON INVESTMENTS CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780836742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9700 RESEARCH DR
Provider Second Line Business Mailing Address:
SUITES 109
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28262-8552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-947-8383
Provider Business Mailing Address Fax Number:
704-947-8385

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9700 RESEARCH DR
Provider Second Line Business Practice Location Address:
SUITES 109
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28262-8552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-947-8383
Provider Business Practice Location Address Fax Number:
704-947-8385
Provider Enumeration Date:
10/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
WATSON
Authorized Official First Name:
LASONYA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
CEO/ADMINISTRATOR
Authorized Official Telephone Number:
704-947-8384

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HC3420 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 6601527 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: HC3420 . This is a "DFS LICENSE NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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