Individual
DR. RUSSELL BRANDON WATTERS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 GRADY RD, ETOWAH, TN 37331-1903
(423) 263-2444
(423) 263-1553
Mailing address
PO BOX 325, ETOWAH, TN 37331-0325
(423) 263-2444
(423) 263-1553
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
023529
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2008341
BCBS
TN
05
—
3069752
—
TN
Enumeration date
04/25/2006
Last updated
11/07/2007
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