Basic Information
| Provider Information | |||||||||
| NPI: | 1457794893 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATERS | ||||||||
| FirstName: | CANDACE | ||||||||
| MiddleName: | MITCHELL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | MEDICAL CENTER BLVD. | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271570001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367161332 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 MANNING DRIVE CAMPUS BOX #7070 | ||||||||
| Address2: | |||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275994216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9849746484 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2013 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2018-00901 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207YX0007X | 2018-00901 | NC | N | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
No ID Information.