Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 069664 | GA |
N | 208600000X | Surgeon | 069664 | GA |
N | 208200000X | Surgeon | 128047 | NC |
N | 208600000X | Surgeon | 128047 | NC |
Y | 2086S0120X | Pediatric Surgery | 069664 | GA |
NPI | 1619005469 |
---|---|
Provider Name | Kenneth Christian Walters |
First Address | Augusta, GA 30901-2602 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 27/09/2013 |