Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DN012296 | GA |
NPI | 1023113875 |
---|---|
Provider Name | Donihue Waters |
First Address | Savannah, GA 31406 |
Second Address | Savannah, GA 31406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/09/2006 |
Last Update Date | 11/12/2014 |