MEDICARE: KENNETH BRIAN WALTON MD

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	208600000X	Surgery Physician	065436	GA
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	065436	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01108293	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	52343669	OTHER	GA	BCBS
3	626252	OTHER	GA	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	014459259	OTHER	GA	AMERIGROUP

General Provider Information

NPI Number	:	1699719179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH BRIAN WALTON MD

Provider Business Mailing Address
First Line	:	PO BOX 689022
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-9022
Country	:	US
Telephone Number	:	615-465-7211
Fax Number	:	615-628-6877

Provider Business Practice Location Address
First Line	:	1497 FAIR RD STE 200
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30458-0824
Country	:	US
Telephone Number	:	912-871-7100
Fax Number	:	912-871-7110

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

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	02/09/2026

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Directions to “ KENNETH BRIAN WALTON MD” Practice Location

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