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General NPI Number Information
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NPI Number | 1336773365
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Entity Type | Individual
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Provider Name | MATTHEW WALKER AUD
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Gender | Male
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Dates
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Enumeration Date | 02/28/2020
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Last Update Date | 04/20/2020
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Provider Practice Location Address
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Address Line | 302 MARGIE DR
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City | WARNER ROBINS
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State | GA
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Zip | 31088-7817
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Country | US
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Telephone | 478-953-2705
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Fax |
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Provider Business Mailing Address
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Address Line | 1021 E 3RD ST
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City | BLOOMINGTON
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State | IN
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Zip | 47405-7005
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Country | US
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Telephone | 601-441-0237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2300269A
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License Number State | IN
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