Provider Demographics
NPI:1437154457
Name:ERHARDT, WALTER L (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:L
Last Name:ERHARDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-1906
Mailing Address - Country:US
Mailing Address - Phone:229-432-9325
Mailing Address - Fax:229-439-4396
Practice Address - Street 1:506 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-1906
Practice Address - Country:US
Practice Address - Phone:229-432-9325
Practice Address - Fax:229-439-4396
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020533208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAB60203Medicare UPIN