Healthcare Provider Details

I. General information

NPI: 1184818502
Provider Name (Legal Business Name): WALTON INNOVATIONS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 INDEPENDENCE DR
AUGUSTA GA
30901-1037
US

IV. Provider business mailing address

1125 TROUPE ST
AUGUSTA GA
30904-4480
US

V. Phone/Fax

Practice location:
  • Phone: 706-823-8503
  • Fax: 706-823-8681
Mailing address:
  • Phone: 706-737-4575
  • Fax: 706-731-5289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number121421
License Number StateGA

VIII. Authorized Official

Name: MR. DENNIS B. SKELLEY
Title or Position: CEO
Credential:
Phone: 706-724-7746