Provider Demographics
NPI:1801869243
Name:WATERS, C CLEVE (MD)
Entity type:Individual
Prefix:DR
First Name:C
Middle Name:CLEVE
Last Name:WATERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1755 GUNBARREL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7137
Mailing Address - Country:US
Mailing Address - Phone:423-855-4044
Mailing Address - Fax:423-855-4105
Practice Address - Street 1:1755 GUNBARREL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7137
Practice Address - Country:US
Practice Address - Phone:423-855-4044
Practice Address - Fax:423-855-4105
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011727207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4135663OtherBCBST
GA000223759BMedicaid
0004216249OtherAETNA
1727929OtherCIGNA
1727929OtherCIGNA
1727929OtherCIGNA
GA000223759BMedicaid