Healthcare Provider Details

I. General information

NPI: 1316282874
Provider Name (Legal Business Name): HANNAH WATERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 01/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 15TH AVE N
BIRMINGHAM AL
35234-2833
US

IV. Provider business mailing address

PO BOX 11523
BIRMINGHAM AL
35202-1523
US

V. Phone/Fax

Practice location:
  • Phone: 205-841-7760
  • Fax: 205-637-2292
Mailing address:
  • Phone: 205-212-5600
  • Fax: 205-212-5660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.867
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: