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NPI Code Detail

MEDICARE: JIM WALTER

MEDICARE: JIM WALTER
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1508086927
Entity Type Code : Individual
Provider Name (Legal Business Name) : JIM WALTER
Provider Business Mailing Address
First Line : PO BOX 167
Second Line :
City : COLLEGEDALE
State : TN
Zip : 37315-0167
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2347 ROSSVILLE BLVD
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37408-2250
Country : US
Telephone Number : 423-265-3122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/26/2007
Last Update Date : 07/08/2007

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