1801829643 NPI number — GRIFFITH GUERRY WALTERS M.D.

Table of content: GRIFFITH GUERRY WALTERS M.D. (NPI 1801829643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801829643 NPI number — GRIFFITH GUERRY WALTERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALTERS
Provider First Name:
GRIFFITH
Provider Middle Name:
GUERRY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1801829643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1414 ELBA HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36079-6020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-670-6726
Provider Business Mailing Address Fax Number:
334-670-6731

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1412 ELBA HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36079-6020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-566-8822
Provider Business Practice Location Address Fax Number:
334-674-0410
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  11496 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 23055 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 145394 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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