Provider Demographics
NPI:1023374956
Name:WATERS, CHRISTOPHER L (DC)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:L
Last Name:WATERS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6542
Mailing Address - Country:US
Mailing Address - Phone:678-714-5722
Mailing Address - Fax:678-714-5724
Practice Address - Street 1:3320 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6542
Practice Address - Country:US
Practice Address - Phone:678-714-5722
Practice Address - Fax:678-714-5724
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-04
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006264111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA35ZCFLPMedicare UPIN