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RENEE L WATERS MD PC NPI 1346462801


NPI Information

NPI: 1346462801
Provider Name: RENEE L WATERS, MD PC

Doing Business As: IVY RIDGE PEDIATRICS

Classification: Pediatrics - 208000000X
Entity Type: Organization
Address:
285 ELM ST
SUITE 102
CUMMING, GA
ZIP 30040
Phone: (770) 205-9457
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RENEE L WATERS, MD PC is a pediatrics in Cumming, GA. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. RENEE L WATERS, MD PC NPI is 1346462801. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Ivy Ridge Pediatrics.

The provider's business location address is:

285 ELM ST
SUITE 102
CUMMING, GA
ZIP 30040-233
Phone: (770) 205-9457
Fax: (678) 947-4060

The provider's authorized official is William Tod Keys .
The authorized official title is Office Manager and has the following contact phone number (770) 205-7799.

The enumeration date for this NPI number is 5/3/2007 and was last updated on 6/25/2008.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1208000000XPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100650339DMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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