Provider Demographics
NPI:1629003348
Name:WATERS, SOPHIA RAWLINGS (MS, PT)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:RAWLINGS
Last Name:WATERS
Suffix:
Gender:F
Credentials:MS, PT
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Mailing Address - Street 1:1741 HOG MOUNTAIN RD
Mailing Address - Street 2:BLDG 100
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-1947
Mailing Address - Country:US
Mailing Address - Phone:706-769-6261
Mailing Address - Fax:706-769-6316
Practice Address - Street 1:1741 HOG MOUNTAIN RD
Practice Address - Street 2:BLDG 100
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-1947
Practice Address - Country:US
Practice Address - Phone:706-769-6261
Practice Address - Fax:706-769-6316
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA04678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAQ24993Medicare UPIN
GA65BBCRCMedicare ID - Type Unspecified