Charles Leroy Waters Jr., LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

MT009572 Issued in GA

Practice address

1 Sherwood Dr
Hinesville, GA 31313-2813

Phone

(912) 332-5965

NPI assigned

Feb 7, 2023

Last updated

Jul 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Zen Den Massage Studio

  • Massage Therapist
  • Hinesville, GA
  • NPI 1689370371
  NPD Authorized official

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

{
    "created_epoch": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688688000000",
    "number": "1912603341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SHERWOOD DR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132813",
            "telephone_number": "912-332-5965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SHERWOOD DR",
            "city": "HINESVILLE",
            "state": "GA",
            "postal_code": "313132813",
            "telephone_number": "912-332-5965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "CHARLES",
        "middle_name": "LEROY",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-07-07",
        "certification_date": "2023-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "GA",
            "license": "MT009572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Unique Renea Walthour
• Victoria Walthour
• Warm and Grace Personal Care Home
• Hannah Mae Warrick
• Annie Washington, RN
• Jessica Denise Waters, PA
• Abigail Watson
• Pamela Watson, FNP
• Lola Mackenzie Watts
• Stephen Weiss, MD

• Massage Therapist in Hinesville, GA
• Providers in Hinesville, GA by specialty
• Massage Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2023; 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.