Provider Demographics
NPI:1316282874
Name:WATERS, HANNAH (PA-C)
Entity type:Individual
Prefix:MRS
First Name:HANNAH
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11523
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-1523
Mailing Address - Country:US
Mailing Address - Phone:205-212-5600
Mailing Address - Fax:205-212-5660
Practice Address - Street 1:2401 15TH AVE N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35234-2833
Practice Address - Country:US
Practice Address - Phone:205-841-7760
Practice Address - Fax:205-637-2292
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical