Provider Demographics
NPI:1144787029
Name:WALKER, ROBERT KING
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KING
Last Name:WALKER
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 1:308 SALLY GRAY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-8937
Mailing Address - Country:US
Mailing Address - Phone:601-410-8393
Mailing Address - Fax:
Practice Address - Street 1:308 SALLY GRAY RD
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-8937
Practice Address - Country:US
Practice Address - Phone:601-604-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS83-3654937OtherTRANSPORT