Healthcare Provider Details

I. General information

NPI: 1194929984
Provider Name (Legal Business Name): HEATHER WHITT WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9181 MEDCOM ST
NORTH CHARLESTON SC
29406-9168
US

IV. Provider business mailing address

PO BOX 1788
MOUNT PLEASANT SC
29465-1788
US

V. Phone/Fax

Practice location:
  • Phone: 843-820-7777
  • Fax: 843-820-7757
Mailing address:
  • Phone: 843-820-7777
  • Fax: 843-820-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0004X
TaxonomySpinal Cord Injury Medicine Physician
License Number2007-00307
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: