MEDICARE: DANIELLE WATERS NP

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	363LF0000X	Family Nurse Practitioner	RN206177	GA

General Provider Information

NPI Number	:	1306986427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE WATERS NP

Provider Business Mailing Address
First Line	:	1804 OVER LAKE DR SE STE A
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1788
Country	:	US
Telephone Number	:	770-679-9935
Fax Number	:	770-679-9938

Provider Business Practice Location Address
First Line	:	1804 OVER LAKE DR SE STE A
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30013-1788
Country	:	US
Telephone Number	:	770-679-9935
Fax Number	:	770-679-9938

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	10/06/2025

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