Healthcare Provider Details

I. General information

NPI: 1225528060
Provider Name (Legal Business Name): WALKER DEHART REDD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2018
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 MASON FARM ROAD 4119B BIOINFORMATICS BLDG
CHAPEL HILL NC
27599-7080
US

IV. Provider business mailing address

651 GRANITE MILL BLVD
CHAPEL HILL NC
27516-4568
US

V. Phone/Fax

Practice location:
  • Phone: 919-966-3997
  • Fax:
Mailing address:
  • Phone: 804-310-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2021-01219
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: