MEDICARE: DR. JIMMIE WALKER JR. D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	5809 C1	AL

General Provider Information

NPI Number	:	1194028431
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIMMIE WALKER JR. D.M.D.

Provider Business Mailing Address
First Line	:	15 11TH CT N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-2303
Country	:	US
Telephone Number	:	205-252-3715
Fax Number	:

Provider Business Practice Location Address
First Line	:	15 11TH CT N
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35204-2303
Country	:	US
Telephone Number	:	205-252-3715
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2010
Last Update Date	:	12/08/2010

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