Provider Demographics
NPI:1568269363
Name:WALKER, DAMETRIUS LADERRICK
Entity type:Individual
Prefix:
First Name:DAMETRIUS
Middle Name:LADERRICK
Last Name:WALKER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WHITTIER DR S
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1450
Mailing Address - Country:US
Mailing Address - Phone:614-816-6967
Mailing Address - Fax:
Practice Address - Street 1:6772 KILOWATT CIR
Practice Address - Street 2:
Practice Address - City:BLACKLICK
Practice Address - State:OH
Practice Address - Zip Code:43004-9553
Practice Address - Country:US
Practice Address - Phone:614-282-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator