1336674621 NPI number — CHARLES A. WALKER DBA WALKER PAIN MANAGEMENT CENTERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336674621 NPI number — CHARLES A. WALKER DBA WALKER PAIN MANAGEMENT CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES A. WALKER DBA WALKER PAIN MANAGEMENT CENTERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336674621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 STONECREEK CIR
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-6021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-664-4850
Provider Business Mailing Address Fax Number:
731-644-0887

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 STONECREEK CIR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-6021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-664-4850
Provider Business Practice Location Address Fax Number:
731-644-0887
Provider Enumeration Date:
04/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
PAGE
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
731-644-0144

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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