Healthcare Provider Details

I. General information

NPI: 1164843991
Provider Name (Legal Business Name): JULIETTE WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SPRUCE ST
WALTERBORO SC
29488-2766
US

IV. Provider business mailing address

8906 TWO NOTCH RD
COLUMBIA SC
29223-6366
US

V. Phone/Fax

Practice location:
  • Phone: 843-781-7428
  • Fax: 843-781-7429
Mailing address:
  • Phone: 803-254-3676
  • Fax: 803-254-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number82426
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: