Active NPI
John Roland Waters, RPH
- Pharmacist
- Jekyll Island, GA
National Provider Identifier
1245340041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 9593
- Practice address
- 10 N Beachview Dr
Jekyll Island, GA 31527-0816 - Phone
- (912) 635-2246
- Fax
- (912) 635-2100
- NPI assigned
- Aug 30, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 9593 | GA | Primary |
Addresses
Primary practice location
10 N Beachview Dr
Jekyll Island, GA 31527-0816
Mailing address
624 Old Plantation Rd
Jekyll Island, GA 31527-0724
Phone (912) 635-3188
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9593 | Other | GA | PHARMACIST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9593 | GA | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hamilton Waters, Inc | Pharmacist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245340041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 OLD PLANTATION RD",
"city": "JEKYLL ISLAND",
"state": "GA",
"postal_code": "315270724",
"telephone_number": "912-635-3188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 N BEACHVIEW DR",
"city": "JEKYLL ISLAND",
"state": "GA",
"postal_code": "315270816",
"telephone_number": "912-635-2246",
"fax_number": "912-635-2100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATERS",
"first_name": "JOHN",
"middle_name": "ROLAND",
"credential": "RPH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "9593",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHARMACIST",
"identifier": "9593",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jekyll Island, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.