Healthcare Provider Details

I. General information

NPI: 1508941501
Provider Name (Legal Business Name): SONDI SAADIA MOORE-WATERS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2260 NORTHLAKE PKWY STE 300
TUCKER GA
30084-4006
US

IV. Provider business mailing address

2260 NORTHLAKE PKWY STE 300
TUCKER GA
30084-4006
US

V. Phone/Fax

Practice location:
  • Phone: 404-297-3440
  • Fax: 770-741-0948
Mailing address:
  • Phone: 404-297-3440
  • Fax: 404-294-6030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number031294
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: