Healthcare Provider Details

I. General information

NPI: 1922250489
Provider Name (Legal Business Name): THOMAS JUERGEN WALKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS WALKER MD

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

IV. Provider business mailing address

5670 PEACHTREE DUNWOODY RD STE 1280
ATLANTA GA
30342-4792
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-1589
  • Fax: 404-257-7409
Mailing address:
  • Phone: 404-257-1589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number70789
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: