MEDICARE: BENJAMIN WALTERS DPT

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	225100000X	Physical Therapist	PT018204	GA

General Provider Information

NPI Number	:	1629926456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN WALTERS DPT

Provider Business Mailing Address
First Line	:	148 GOVERNOR LN
Second Line	:
City	:	TEMPLE
State	:	GA
Zip	:	30179-3169
Country	:	US
Telephone Number	:	229-942-8520
Fax Number	:

Provider Business Practice Location Address
First Line	:	5829 CAMPBELLTON RD SW STE 112&113
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8037
Country	:	US
Telephone Number	:	404-885-8869
Fax Number	:

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

Provider Enumeration Date	:	03/18/2026
Last Update Date	:	03/18/2026

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