Individual
WILLIAM C WATERS IV
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 DIXIE ST, CARROLLTON, GA 30117-3818
(770) 832-1488
Mailing address
PO BOX 1845, CARROLLTON, GA 30112-0035
(770) 832-1488
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
029969
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10049622
AMERIGROUP
GA
01
—
306327
WELLCARE
GA
Enumeration date
06/16/2006
Last updated
07/08/2007
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