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General NPI Number Information
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NPI Number | 1043103682
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Entity Type | Organization
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Legal Business Name | PRIMAL MEDICAL AND WELLNESS LLC
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Dates
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Enumeration Date | 06/02/2025
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Last Update Date | 06/02/2025
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Provider Practice Location Address
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Address Line | 1031 KEITH DR STE 101
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City | PERRY
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State | GA
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Zip | 31069-2948
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Country | US
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Telephone | 478-390-6984
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 25
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City | FORSYTH
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State | GA
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Zip | 31029-0025
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Country | US
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Telephone | 478-390-6984
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUKE WALKER
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Credential | MD
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Telephone | 478-244-1065
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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