Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 026198 | GA |
NPI | 1003808718 |
---|---|
Provider Name | Dr. Gary Leonard Walker |
First Address | Snellville, GA 30078-6782 |
Second Address | Snellville, GA 30078-6782 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 29/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D-46400 | (02) | GA |