MEDICARE: DR. CRAIG W WALKER DMD

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	1223G0001X	General Practice Dentistry	9394	GA

General Provider Information

NPI Number	:	1962573535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRAIG W WALKER DMD

Provider Business Mailing Address
First Line	:	1188 CROSS ST
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3225
Country	:	US
Telephone Number	:	706-861-5263
Fax Number	:

Provider Business Practice Location Address
First Line	:	1188 CROSS ST
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3225
Country	:	US
Telephone Number	:	706-861-5263
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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