Individual
MR. GARY DOUGLAS WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSC, CCC-S
Contact information
Practice address
2424 DOUBLE CHURCHES RD, COLUMBUS, GA 31909-2741
(706) 324-6112
(706) 596-8259
Mailing address
2424 DOUBLE CHURCHES RD, COLUMBUS, GA 31909-2741
(334) 745-2792
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP000655
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308298384A
—
GA
01
—
52164429
BCBS OF GA PROVIDER NUMBE
GA
Enumeration date
12/19/2006
Last updated
08/29/2008
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