Provider Demographics
NPI:1790716272
Name:WATERS, SHARON Y (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:Y
Last Name:WATERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:Y
Other - Last Name:WATERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3495 PIEDMONT ROAD, NE
Mailing Address - Street 2:NINE PIEDMONT CENTER
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305
Mailing Address - Country:US
Mailing Address - Phone:404-364-7070
Mailing Address - Fax:
Practice Address - Street 1:750 TOWNPARK LANE
Practice Address - Street 2:KAISER PERMANENTE TOWNPARK COMPREHENSIVE MEDICAL CENTER
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-514-5401
Practice Address - Fax:865-291-3228
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043313207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000776597MMedicaid
GA000776597MMedicaid
GA93BFBCCMedicare ID - Type Unspecified