MEDICARE: MR. JOHN M WALTERS LISW

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	1041C0700X	Clinical Social Worker	10353	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SCE8389223	OTHER	SC	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427132976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN M WALTERS LISW

Provider Business Mailing Address
First Line	:	PO BOX 751649
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1649
Country	:	US
Telephone Number	:	843-789-1620
Fax Number	:	843-724-2440

Provider Business Practice Location Address
First Line	:	2097 HENRY TECKLENBURG DR STE 211W
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-5739
Country	:	US
Telephone Number	:	843-958-2555
Fax Number	:	843-402-1961

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

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	02/21/2022

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Directions to “ MR. JOHN M WALTERS LISW” Practice Location

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