Healthcare Provider Details

I. General information

NPI: 1164131108
Provider Name (Legal Business Name): WALKERS UNRIVALED SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 HIGHLAND GATE DR
CUMMING GA
30040-6366
US

IV. Provider business mailing address

2120 HIGHLAND GATE DR
CUMMING GA
30040-6366
US

V. Phone/Fax

Practice location:
  • Phone: 470-262-2848
  • Fax:
Mailing address:
  • Phone: 470-262-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name: ANFERNEE JEROME WALKER
Title or Position: CERTIFIED SURGICAL ASSISTANT
Credential: CSA
Phone: 470-262-2848