Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 89391 | GA |
NPI | 1073970091 |
---|---|
Provider Name | Scott Walton |
First Address | Fort Gordon, GA 30905-5650 |
Second Address | Ft. Gordon, GA 30905-5650 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2016 |
Last Update Date | 10/08/2021 |