Provider Demographics
NPI:1992145940
Name:WALKER, DARRELL D (DDS)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:D
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8078
Mailing Address - Country:US
Mailing Address - Phone:615-209-8699
Mailing Address - Fax:
Practice Address - Street 1:445 HIGHWAY 46 S
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-2545
Practice Address - Country:US
Practice Address - Phone:615-326-5313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-04
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015557122300000X
TN9934122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist