Healthcare Provider Details

I. General information

NPI: 1891793840
Provider Name (Legal Business Name): CHRISTOPHER S WATTERS CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/03/2020
Certification Date: 06/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL DR
LEXINGTON NC
27292-6792
US

IV. Provider business mailing address

162 HOLLOW TREE CT
WINSTON SALEM NC
27127-9236
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-2255
  • Fax: 336-716-3202
Mailing address:
  • Phone: 910-489-2171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number198474
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: