Provider Demographics
NPI:1285678631
Name:WATTERS SURGICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:WATTERS SURGICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:WATTERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-431-9911
Mailing Address - Street 1:1212 CEDARHURST DR
Mailing Address - Street 2:STE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609
Mailing Address - Country:US
Mailing Address - Phone:919-431-9911
Mailing Address - Fax:919-850-1397
Practice Address - Street 1:1212 CEDARHURST DR
Practice Address - Street 2:STE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609
Practice Address - Country:US
Practice Address - Phone:919-431-9911
Practice Address - Fax:919-850-1397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34194208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8986021Medicaid
NC8986021Medicaid
2159456CMedicare ID - Type Unspecified