Healthcare Provider Details

I. General information

NPI: 1003881228
Provider Name (Legal Business Name): GEORGE CLIFFORD WALTON M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12101 S CHALKLEY RD
CHESTER VA
23831-3755
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 804-796-3636
  • Fax:
Mailing address:
  • Phone: 804-822-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101053686
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: