Provider Demographics
NPI:1730140294
Name:WATTERS, JOSEPH E (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:E
Last Name:WATTERS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1134
Mailing Address - Country:US
Mailing Address - Phone:256-456-0226
Mailing Address - Fax:256-456-0231
Practice Address - Street 1:100 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 205
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1134
Practice Address - Country:US
Practice Address - Phone:256-456-0226
Practice Address - Fax:256-456-0231
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2016-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-055363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL168709Medicaid
AL168709Medicaid
ALR69069Medicare UPIN