Provider Demographics
NPI:1285854901
Name:JAMES H. WALKER,III DBA SANDY SPRINGS FAMILY PRACTICE
Entity Type:Organization
Organization Name:JAMES H. WALKER,III DBA SANDY SPRINGS FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:864-261-9100
Mailing Address - Street 1:PO BOX 450
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29677-0450
Mailing Address - Country:US
Mailing Address - Phone:864-261-9100
Mailing Address - Fax:
Practice Address - Street 1:5304 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:SC
Practice Address - Zip Code:29670-9139
Practice Address - Country:US
Practice Address - Phone:864-261-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC109572261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC080006182OtherRAILROAD MEDICARE
SCGPO311Medicaid
SC0992920001Medicare NSC
SC080006182OtherRAILROAD MEDICARE
SC3081Medicare ID - Type Unspecified