Provider Demographics
NPI:1932118643
Name:WALTERS, ROBERT G (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4976 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5470
Mailing Address - Country:US
Mailing Address - Phone:423-497-5355
Mailing Address - Fax:423-308-0281
Practice Address - Street 1:7425 ZIEGLER RD STE 101
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-4178
Practice Address - Country:US
Practice Address - Phone:423-702-9218
Practice Address - Fax:423-702-9219
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN834213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480035000OtherRAILROAD MEDICARE
TNQ037426Medicaid
IL1932118643 1Medicaid
IL909010OtherMEDICARE GROUP
ILU86305Medicare UPIN
IL1932118643 1Medicaid