Healthcare Provider Details

I. General information

NPI: 1285854901
Provider Name (Legal Business Name): JAMES H. WALKER,III DBA SANDY SPRINGS FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5304 HIGHWAY 76
PENDLETON SC
29670-9139
US

IV. Provider business mailing address

PO BOX 450
SANDY SPRINGS SC
29677-0450
US

V. Phone/Fax

Practice location:
  • Phone: 864-261-9100
  • Fax:
Mailing address:
  • Phone: 864-261-9100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number109572
License Number StateSC

VIII. Authorized Official

Name: JAMES H WALKER III
Title or Position: OWNER
Credential: M.D.
Phone: 864-261-9100