Healthcare Provider Details

I. General information

NPI: 1356960686
Provider Name (Legal Business Name): ABDUL ABEL WALTERS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BB4515
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

1120 15TH ST # BB-4515
AUGUSTA GA
30912-0006
US

V. Phone/Fax

Practice location:
  • Phone: 215-248-8200
  • Fax:
Mailing address:
  • Phone: 706-721-7702
  • Fax: 706-721-3239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: