MEDICARE: PAUL RUFUS WALKER II

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1275317257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL RUFUS WALKER II

Provider Business Mailing Address
First Line	:	5617 PRINCETON AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3483
Country	:	US
Telephone Number	:	706-257-7723
Fax Number	:

Provider Business Practice Location Address
First Line	:	5617 PRINCETON AVE STE B
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-3483
Country	:	US
Telephone Number	:	706-257-7723
Fax Number	:

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

Provider Enumeration Date	:	08/22/2023
Last Update Date	:	08/22/2023

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