MEDICARE: DR. WALTER L MYERS DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7090	GA

General Provider Information

NPI Number	:	1588692537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER L MYERS DDS

Provider Business Mailing Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1202
City	:	ATLANTA
State	:	GA
Zip	:	30361-6202
Country	:	US
Telephone Number	:	404-874-1115
Fax Number	:	404-874-0624

Provider Business Practice Location Address
First Line	:	1175 PEACHTREE ST NE
Second Line	:	SUITE 1202
City	:	ATLANTA
State	:	GA
Zip	:	30361-6202
Country	:	US
Telephone Number	:	404-874-1115
Fax Number	:	404-874-0624

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	07/08/2007

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