Healthcare Provider Details

I. General information

NPI: 1629031661
Provider Name (Legal Business Name): JOHN RISHEL WALKER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 05/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2095 HENRY TECKLENBURG DR
CHARLESTON SC
29414
US

IV. Provider business mailing address

2095 HENRY TECKLENBURG DR
CHARLESTON SC
29414-5733
US

V. Phone/Fax

Practice location:
  • Phone: 843-513-4255
  • Fax:
Mailing address:
  • Phone: 843-513-4255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number02242
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: