Provider Demographics
NPI:1154389369
Name:WALKER, CHARLES ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANDREW
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1502 E EVANS ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4364
Mailing Address - Country:US
Mailing Address - Phone:229-243-1700
Mailing Address - Fax:229-246-9322
Practice Address - Street 1:1502 E EVANS ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4364
Practice Address - Country:US
Practice Address - Phone:229-243-1700
Practice Address - Fax:229-246-9322
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029816208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000422177BMedicaid
GA029816OtherMEDICAL LICENSE
GAF28624Medicare UPIN
GA02BDJFGMedicare PIN