Provider Demographics
NPI:1326350075
Name:WALTON-SAMPSON, TAMALA (DPM)
Entity Type:Individual
Prefix:DR
First Name:TAMALA
Middle Name:
Last Name:WALTON-SAMPSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 JOHN MADDOX DR NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30165-1419
Mailing Address - Country:US
Mailing Address - Phone:706-232-6739
Mailing Address - Fax:
Practice Address - Street 1:101 JOHN MADDOX DR NW
Practice Address - Street 2:SUITE A
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1419
Practice Address - Country:US
Practice Address - Phone:706-232-6739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD001225213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist