Renee L Waters, MD PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

RENEE L WATERS, MD PC

Practice address

285 Elm St
Suite 102
Cumming, GA 30040-8233

Phone

(770) 205-9457

Fax

(678) 947-4060

NPI assigned

May 3, 2007

Organization subpart

No

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

Authorized official

Name

William Tod Keys

Title

Office Manager

Phone

(770) 205-7799

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• IVY RIDGE PEDIATRICS Doing business as

Locations

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1346462801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 ELM ST",
            "address_2": "SUITE 102",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300408233",
            "telephone_number": "770-205-9457",
            "fax_number": "678-947-4060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 ELM ST",
            "address_2": "SUITE 102",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300408233",
            "telephone_number": "770-205-9457",
            "fax_number": "678-947-4060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENEE L WATERS, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "KEYS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "TOD",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "770-205-7799"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00650339D",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "IVY RIDGE PEDIATRICS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tyler Christian Reinoso, PTA
• John Reitz
• Relief Flow LLC
• Russell G Remalia, DO
• Renal Carepartners of Cumming LLC
• Nicole Emilia Renfroe, ATC
• Brandon J Rennick, D.C.
• Rescue Nine Inc
• Resq Ambulance Service LLC
• Restful Retreat

• Pediatrics Physician in Cumming, GA
• Providers in Cumming, GA by specialty
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; 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.