Healthcare Provider Details

I. General information

NPI: 1356382345
Provider Name (Legal Business Name): MARK LAMONT WALKER M.D., F.A.C.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 03/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 CLEVELAND AVE SW SUITE 305
ATLANTA GA
30315-7129
US

IV. Provider business mailing address

777 CLEVELAND AVE SW SUITE 305
ATLANTA GA
30315-7129
US

V. Phone/Fax

Practice location:
  • Phone: 404-761-7482
  • Fax: 404-761-8398
Mailing address:
  • Phone: 404-761-7482
  • Fax: 404-761-8398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number026953
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number026953
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: