Provider Demographics
NPI:1508941501
Name:MOORE-WATERS, SONDI SAADIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SONDI
Middle Name:SAADIA
Last Name:MOORE-WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 NORTHLAKE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-4006
Mailing Address - Country:US
Mailing Address - Phone:404-297-3440
Mailing Address - Fax:404-294-6030
Practice Address - Street 1:2260 NORTHLAKE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-4006
Practice Address - Country:US
Practice Address - Phone:404-297-3440
Practice Address - Fax:770-741-0948
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031294207Q00000X
GA31294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000509704KMedicaid
GA000509704JMedicaid
GA202I084864Medicare PIN
GA000509704JMedicaid