MEDICARE: DR. CHRISTOPHER WATERS PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH028529	GA

General Provider Information

NPI Number	:	1710333851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER WATERS PHARMD

Provider Business Mailing Address
First Line	:	1326 AMANDA CIR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-1903
Country	:	US
Telephone Number	:	912-237-1545
Fax Number	:

Provider Business Practice Location Address
First Line	:	660 WHITLOCK AVE NW STE G
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30064-3174
Country	:	US
Telephone Number	:	770-514-1414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2016
Last Update Date	:	09/10/2020

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