Provider Demographics
NPI:1336662824
Name:WALTON, WILLIAM (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:WALTON
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 INDEPENDENCE DR STE D
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7814
Mailing Address - Country:US
Mailing Address - Phone:478-333-5024
Mailing Address - Fax:706-243-6497
Practice Address - Street 1:644 TALLULAH TRL
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7625
Practice Address - Country:US
Practice Address - Phone:478-225-2179
Practice Address - Fax:706-243-6497
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-17-26263103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty