Healthcare Provider Details

I. General information

NPI: 1184668246
Provider Name (Legal Business Name): WILLIAM WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MERIT HEALTH MEDICAL GROUP-SUMRALL 4891 HWY 589
SUMRALL MS
39482-3948
US

IV. Provider business mailing address

MERIT HEALTH MEDICAL GROUP-SUMRALL 4891 HWY 589
SUMRALL MS
39482-5218
US

V. Phone/Fax

Practice location:
  • Phone: 601-758-4606
  • Fax: 601-758-4615
Mailing address:
  • Phone: 17-584-6066
  • Fax: 601-758-4615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number08061
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number08061
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: