Provider Demographics
NPI:1184818502
Name:WALTON INNOVATIONS INC.
Entity Type:Organization
Organization Name:WALTON INNOVATIONS INC.
Other - Org Name:WALTON INNOVATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:SKELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-724-7746
Mailing Address - Street 1:1125 TROUPE ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4480
Mailing Address - Country:US
Mailing Address - Phone:706-737-4575
Mailing Address - Fax:706-731-5289
Practice Address - Street 1:1355 INDEPENDENCE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1037
Practice Address - Country:US
Practice Address - Phone:706-823-8503
Practice Address - Fax:706-823-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121421283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPA954Medicaid
511G700249Medicare PIN