Healthcare Provider Details

I. General information

NPI: 1801829643
Provider Name (Legal Business Name): GRIFFITH GUERRY WALTERS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 06/14/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 ELBA HWY
TROY AL
36079-6020
US

IV. Provider business mailing address

1414 ELBA HWY
TROY AL
36079-6020
US

V. Phone/Fax

Practice location:
  • Phone: 334-566-8822
  • Fax: 334-674-0410
Mailing address:
  • Phone: 334-670-6726
  • Fax: 334-670-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number11496
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23055
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: