Provider Demographics
NPI:1124072079
Name:RAY, WALKER L JR (MD)
Entity type:Individual
Prefix:
First Name:WALKER
Middle Name:L
Last Name:RAY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WALKER
Other - Middle Name:LEWIS
Other - Last Name:RAY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:STE 411
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084
Mailing Address - Country:US
Mailing Address - Phone:770-491-6360
Mailing Address - Fax:770-493-5572
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:STE 411
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084
Practice Address - Country:US
Practice Address - Phone:770-491-6360
Practice Address - Fax:770-493-5572
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011041208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics