Provider Demographics
NPI:1194028431
Name:WALKER, JIMMIE JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JIMMIE
Middle Name:
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 11TH CT N
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35204-2303
Mailing Address - Country:US
Mailing Address - Phone:205-252-3715
Mailing Address - Fax:
Practice Address - Street 1:15 11TH CT N
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35204-2303
Practice Address - Country:US
Practice Address - Phone:205-252-3715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5809 C1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist