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1720380843 NPI number — ANTHONY JOSEPH WALTERS CLINICAL SOCIAL WORK

NPI Number: 1720380843
Health Care Provider/Practitioner: ANTHONY JOSEPH WALTERS CLINICAL SOCIAL WORK

Information about “1720380843” NPI (ANTHONY JOSEPH WALTERS CLINICAL SOCIAL WORK) exists in 1720380843 in HTML format HTML  |  1720380843 in plain Text format TXT  |  1720380843 in PDF (Portable Document Format) PDF  |  1720380843 in an XML format XML  formats.

NPI Number : 1720380843 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1720380843",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALTERS",
    "FirstName": "ANTHONY",
    "MiddleName": "JOSEPH",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "CLINICAL SOCIAL WORK",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "515B CITY BOULEVARD",
    "SecondLineMailingAddress": "WAYCROSS RURAL INITATIVE CLINIC",
    "MailingAddressCityName": "WAYCROSS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31501-8016",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "912-279-4400",
    "MailingAddressFaxNumber": "912-279-4448",
    "FirstLinePracticeLocationAddress": "515B CITY BOULEVARD",
    "SecondLinePracticeLocationAddress": "WAYCROSS VA OUTREACH CLINIC",
    "PracticeLocationAddressCityName": "WAYCROSS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31501-8016",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "912-279-4400",
    "PracticeLocationAddressFaxNumber": "912-279-4448",
    "EnumerationDate": "11/22/2010",
    "LastUpdateDate": "11/22/2010",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "CSW004249",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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