Healthcare Provider Details

I. General information

NPI: 1639519762
Provider Name (Legal Business Name): WALKER COMPREHENSIVE PAIN CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2013
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CENTER DR SUITE 20
JASPER AL
35501-3425
US

IV. Provider business mailing address

PO BOX 1427
JASPER AL
35502-1427
US

V. Phone/Fax

Practice location:
  • Phone: 205-221-5374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN GREENE
Title or Position: PRESIDENT
Credential: MD
Phone: 334-386-2051