Provider Demographics
NPI:1902164890
Name:WALTER L. ERHARDT, JR., MD, PC
Entity type:Organization
Organization Name:WALTER L. ERHARDT, JR., MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:ERHARDT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:229-432-9325
Mailing Address - Street 1:506 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1906
Mailing Address - Country:US
Mailing Address - Phone:229-432-9325
Mailing Address - Fax:229-439-4396
Practice Address - Street 1:506 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1906
Practice Address - Country:US
Practice Address - Phone:229-432-9325
Practice Address - Fax:229-439-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020533208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB60203Medicare UPIN