Provider Demographics
NPI:1003929472
Name:WATTERS, DONALD H (MD)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:H
Last Name:WATTERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6141 SHALLOWFORD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1663
Mailing Address - Country:US
Mailing Address - Phone:423-498-2005
Mailing Address - Fax:423-498-2001
Practice Address - Street 1:6141 SHALLOWFORD RD STE 100
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1663
Practice Address - Country:US
Practice Address - Phone:423-498-2000
Practice Address - Fax:423-498-2001
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN141612083A0300X, 207Q00000X, 2083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ059162Medicaid
TN1528489Medicaid
TN3197563Medicare ID - Type UnspecifiedMEDICARE
TN1528489Medicaid