Provider Demographics
NPI:1902271604
Name:WATERS, MEMORI MCCARLEY (CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:MEMORI
Middle Name:MCCARLEY
Last Name:WATERS
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MEMORI
Other - Middle Name:KAY
Other - Last Name:MCCARLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:1112 W 12TH ST
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:GA
Mailing Address - Zip Code:31510-1814
Mailing Address - Country:US
Mailing Address - Phone:912-632-8244
Mailing Address - Fax:912-632-7041
Practice Address - Street 1:1112 W 12TH ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:GA
Practice Address - Zip Code:31510-1814
Practice Address - Country:US
Practice Address - Phone:912-632-8244
Practice Address - Fax:912-632-7041
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN202155363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics