Individual
HEATHER ELIZABETH WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
596 W 11TH AVE, LUMBERTON, MS 39455-2350
(601) 596-4215
(601) 796-9437
Mailing address
PO BOX 1729, HATTIESBURG, MS 39403-1729
(601) 545-8700
(601) 255-2645
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
21796
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008504826
—
MS
01
—
21796
MS MEDICAL LICENSE
—
Enumeration date
06/23/2010
Last updated
11/15/2024
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