Provider Demographics
NPI:1457473241
Name:WALKER, JOHN LEROY (CSA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LEROY
Last Name:WALKER
Suffix:
Gender:M
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 923821
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30010-3821
Mailing Address - Country:US
Mailing Address - Phone:770-985-4257
Mailing Address - Fax:770-985-4258
Practice Address - Street 1:3688 CREEKSTONE DR
Practice Address - Street 2:
Practice Address - City:PEACHTREE CORNERS
Practice Address - State:GA
Practice Address - Zip Code:30092-2474
Practice Address - Country:US
Practice Address - Phone:678-691-6529
Practice Address - Fax:770-840-7464
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical