Provider Demographics
NPI:1457333650
Name:WATERS-HWANG, DOROTHY SHANNON (MD)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:SHANNON
Last Name:WATERS-HWANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:SHANNON
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2350 SCHILLINGER ROAD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695
Mailing Address - Country:US
Mailing Address - Phone:251-445-7614
Mailing Address - Fax:251-410-6127
Practice Address - Street 1:2350 SCHILLINGER ROAD S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695
Practice Address - Country:US
Practice Address - Phone:251-445-7614
Practice Address - Fax:251-410-6127
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26064207P00000X
IDM-13371207R00000X
KY33210207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51523731OtherBLUE CROSS BLUE SHIELD
AL51523731OtherBLUE CROSS BLUE SHIELD
G80011Medicare UPIN