Healthcare Provider Details

I. General information

NPI: 1841572518
Provider Name (Legal Business Name): JOHN GABRIEL WALKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2011
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD STE 110
WATKINSVILLE GA
30677-7241
US

IV. Provider business mailing address

200 MONTGOMERY HWY STE 200
VESTAVIA AL
35216-1842
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone: 901-260-8551
  • Fax: 901-260-8590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1003
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2015
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9667
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: