Provider Demographics
NPI:1588692537
Name:MYERS, WALTER L (DDS)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:L
Last Name:MYERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1175 PEACHTREE ST NE
Mailing Address - Street 2:SUITE 1202
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30361-6202
Mailing Address - Country:US
Mailing Address - Phone:404-874-1115
Mailing Address - Fax:404-874-0624
Practice Address - Street 1:1175 PEACHTREE ST NE
Practice Address - Street 2:SUITE 1202
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30361-6202
Practice Address - Country:US
Practice Address - Phone:404-874-1115
Practice Address - Fax:404-874-0624
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70901223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA70023619DAMedicare ID - Type Unspecified
GAU41161Medicare UPIN