Healthcare Provider Details

I. General information

NPI: 1750386637
Provider Name (Legal Business Name): WALTER BEROSKY ATKINS D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MARTIN LUTHER KING JR DR SW STE 300
ATLANTA GA
30310-5801
US

IV. Provider business mailing address

2001 MARTIN LUTHER KING JR DR SW STE 300
ATLANTA GA
30310-5801
US

V. Phone/Fax

Practice location:
  • Phone: 404-755-0020
  • Fax: 404-755-6960
Mailing address:
  • Phone: 404-755-0020
  • Fax: 404-755-6960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number000699
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: