Provider Demographics
NPI:1699956680
Name:WALKER, JAMELL EDWINA (MD)
Entity type:Individual
Prefix:DR
First Name:JAMELL
Middle Name:EDWINA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4591 CRESTDALE CT
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5818
Mailing Address - Country:US
Mailing Address - Phone:850-878-0101
Mailing Address - Fax:
Practice Address - Street 1:5955 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-2423
Practice Address - Country:US
Practice Address - Phone:305-661-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-18
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109079207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003416300Medicaid
LA50010Medicaid
FLEV555ZMedicare PIN