Provider Demographics
NPI:1114147196
Name:LEVIE, WALTER HILL JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:HILL
Last Name:LEVIE
Suffix:JR
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 1:201 E VILLANOW ST
Mailing Address - Street 2:P.O. BOX 1725
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-2520
Mailing Address - Country:US
Mailing Address - Phone:706-638-2784
Mailing Address - Fax:706-638-7428
Practice Address - Street 1:201 E VILLANOW ST
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-2520
Practice Address - Country:US
Practice Address - Phone:706-638-2784
Practice Address - Fax:706-638-7428
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0094491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice