Provider Demographics
NPI:1023079845
Name:WATTERS, JOHN L III (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:WATTERS
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1820
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28793-1820
Mailing Address - Country:US
Mailing Address - Phone:828-693-3193
Mailing Address - Fax:
Practice Address - Street 1:643 5TH AVE W
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28739-4205
Practice Address - Country:US
Practice Address - Phone:828-693-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89138FVMedicaid
NC2028703AMedicare ID - Type Unspecified
NCI12826Medicare UPIN