Walton, Phillip Gene
Walton, Phillip Gene is an individual health care provider with primary practice located at 3995 Covington Hwy , Decatur GA 30032-2645. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Walton, Phillip Gene can be contacted via phone (404) 284-6911.Contact Information
Primary practice address
3995 Covington Hwy
Decatur GA 30032-2645
Phone: (404) 284-6911
Fax: (404) 288-4165
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | DN008971 | Georgia |
Profile Details
| NPI number | 1730125568 |
|---|---|
| LBN Legal business name | Walton, Phillip Gene |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2006 |
| Last updated | Oct 18th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1730125568 | NPPES |
| Georgia | Other | 9180345 | AMERIGROUP MEDICADE |
| Georgia | MEDICAID | 00213056A | AMERIGROUP MEDICADE |
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