Healthcare Provider Details

I. General information

NPI: 1588096259
Provider Name (Legal Business Name): BRIAN SCOTT WALKER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 UPPER RIVERDALE RD
JONESBORO GA
30236-1099
US

IV. Provider business mailing address

3647 SHEFFIELD PL
TUCKER GA
30084-7120
US

V. Phone/Fax

Practice location:
  • Phone: 770-907-5743
  • Fax: 770-907-5746
Mailing address:
  • Phone: 678-429-9035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT011140
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: