Provider Demographics
NPI:1306986427
Name:WATERS, DANIELLE (NP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1804 OVER LAKE DR SE STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-1788
Mailing Address - Country:US
Mailing Address - Phone:770-679-9935
Mailing Address - Fax:770-679-9938
Practice Address - Street 1:1804 OVER LAKE DR SE STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-1788
Practice Address - Country:US
Practice Address - Phone:770-679-9935
Practice Address - Fax:770-679-9938
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2025-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN206177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABI900ZMedicare UPIN