Healthcare Provider Details

I. General information

NPI: 1629458906
Provider Name (Legal Business Name): ANDREW WALKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 07/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UNION AVE
MEMPHIS TN
38104-3415
US

IV. Provider business mailing address

6060 PRIMACY PKWY STE 241
MEMPHIS TN
38119-5743
US

V. Phone/Fax

Practice location:
  • Phone: 901-725-5846
  • Fax:
Mailing address:
  • Phone: 901-725-5846
  • 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 Code207L00000X
TaxonomyAnesthesiology Physician
License Number56872
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: