Mary Amanda Jackson-Watson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2012-01376 Issued in NC

Practice address

5427 NC Highway 49 S
Ste 103
Harrisburg, NC 28075-7408

Phone

(704) 455-5565

NPI assigned

Jan 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mjacksonwatson136498@carolinashealthcaresystem.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Charlotte-Mecklenburg Hospital Authority

  dba Levine Cancer Institute

  • Hematology & Oncology Physician
  • Charlotte, NC
  • NPI 1033489687
  NPD (past)
• The Charlotte-Mecklenburg Hospital Authority

  dba Atrium Health Levine Children's Rocky River Pediatrics

  • Pediatrics Physician
  • Harrisburg, NC
  • NPI 1053748426
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1962749390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19305",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282199305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5427 NC HIGHWAY 49 S",
            "address_2": "STE 103",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757408",
            "telephone_number": "704-455-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-WATSON",
        "first_name": "MARY",
        "middle_name": "AMANDA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-04",
        "last_updated": "2024-07-15",
        "certification_date": "2023-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2012-01376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mjacksonwatson136498@CarolinasHealthcareSystem.direct-ci.com",
            "affiliation": "Y",
            "affiliationName": "Atrium Health",
            "address_1": "5427 Nc Highway 49 S",
            "address_2": "Ste 103",
            "city": "Harrisburg",
            "state": "NC",
            "country_code": "US",
            "postal_code": "280757408",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "ABILITY Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "100 N 6th St Ste 900A",
            "city": "Minneapolis",
            "state": "MN",
            "country_code": "US",
            "postal_code": "554031516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• David A Hysell, PT
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• Mark Winslow Icard, D.D.S.
• In His Hands: an Integrative Approach to Health and Wellness, PLLC
• Inreach
• Latresha Jackson
• Natalie Belk Jarvis
• JLN Counseling, PLLC
• Ebonie Johnson, OTR/L
• Jeffrey Chad Johnson, D.D.S.

• Pediatrics Physician in Harrisburg, NC
• Providers in Harrisburg, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.