Father of Waters Emergency Physicians LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

FATHER OF WATERS EMERGENCY PHYSICIANS LLC

Practice address

14365 Highway 16 W
De Kalb, MS 39328-7974

Phone

(800) 444-7009

NPI assigned

Jan 21, 2011

Last updated

Aug 25, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kathleen Kondas

Title

Officer

Phone

(954) 838-2371

Specialties & licenses 1

Addresses

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrea D. Goodwin, M.D.

  • Obesity Medicine (Family Medicine) Physician
  • Meridian, MS
  • NPI 1285616870
  NPD (past)
• Lon F. Alexander, M.D.

  • Neurological Surgery Physician
  • Flower Mound, TX
  • NPI 1073595989
  NPD (past)
• Howard Thomas Cusick III, M.D.

  • Occupational Medicine Clinic/Center
  • Durham, NC
  • NPI 1912007881

  Emergency Medicine

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1295568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566691200000",
    "number": "1194020248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13737 NOEL RD",
            "address_2": "STE 1600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752401331",
            "telephone_number": "954-838-2371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14365 HIGHWAY 16 W",
            "city": "DE KALB",
            "state": "MS",
            "postal_code": "393287974",
            "telephone_number": "800-444-7009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FATHER OF WATERS EMERGENCY PHYSICIANS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-21",
        "last_updated": "2019-08-25",
        "status": "A",
        "authorized_official_last_name": "KONDAS",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "954-838-2371"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Martin Bracken, DO
• Patricia Dunlap, MD
• Latorie Dunn-King, CMHT
• Emmanuel Ridge of Dekalb Inc (Adult Daycare Health Services)
• Haley Ezelle
• Brandon Nicholas Goza, D.M.D.
• Hannah Gray, FNP
• Greater Meridian Health Clinic, Inc. (Kemper Family Medical Center)
• Anna Marie Hailey-Sharp, MD
• Happy at Home Personal Care Services

• Emergency Medicine Physician in De Kalb, MS
• Providers in De Kalb, MS by specialty
• Emergency Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.