Provider Demographics
NPI:1568047363
Name:WATERS, CHASTITY
Entity Type:Individual
Prefix:MS
First Name:CHASTITY
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 HANKS AVE
Mailing Address - Street 2:
Mailing Address - City:GEORGIANA
Mailing Address - State:AL
Mailing Address - Zip Code:36033-3502
Mailing Address - Country:US
Mailing Address - Phone:334-437-4375
Mailing Address - Fax:
Practice Address - Street 1:241 HANKS AVE
Practice Address - Street 2:
Practice Address - City:GEORGIANA
Practice Address - State:AL
Practice Address - Zip Code:36033-3502
Practice Address - Country:US
Practice Address - Phone:334-437-4375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker