1629003348 NPI number — MRS. SOPHIA RAWLINGS WATERS M.S., P.T.

Table of content: MRS. SOPHIA RAWLINGS WATERS M.S., P.T. (NPI 1629003348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629003348 NPI number — MRS. SOPHIA RAWLINGS WATERS M.S., P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WATERS
Provider First Name:
SOPHIA
Provider Middle Name:
RAWLINGS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629003348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1741 HOG MOUNTAIN RD
Provider Second Line Business Mailing Address:
BLDG 100
Provider Business Mailing Address City Name:
WATKINSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30677-1947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-769-6261
Provider Business Mailing Address Fax Number:
706-769-6316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1741 HOG MOUNTAIN RD
Provider Second Line Business Practice Location Address:
BLDG 100
Provider Business Practice Location Address City Name:
WATKINSVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30677-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-769-6261
Provider Business Practice Location Address Fax Number:
706-769-6316
Provider Enumeration Date:
07/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  04678 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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