Individual
JARED WATERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5673 AIRPORT RD, ROANOKE, VA 24012-1119
(540) 523-8080
Mailing address
3111 GRAYLAND AVE, RICHMOND, VA 23221-3527
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009479
VA
Other
Enumeration date
05/29/2023
Last updated
08/17/2023
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