Provider Demographics
NPI:1003504903
Name:FLEMISTER, WALTER
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:
Last Name:FLEMISTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6220 SHALLOWFORD RD APT 462
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-5492
Mailing Address - Country:US
Mailing Address - Phone:914-548-1037
Mailing Address - Fax:
Practice Address - Street 1:6220 SHALLOWFORD RD APT 462
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-5492
Practice Address - Country:US
Practice Address - Phone:914-548-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)