Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | 011086 | GA |
NPI | 1013935725 |
---|---|
Provider Name | Dr. Jerome Massee Walker JR. |
First Address | Decatur, GA 30033-4167 |
Second Address | Decatur, GA 30033-4167 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00039949G | (05) | GA |
D41304 | (02) | GA |