Provider Demographics
NPI:1578856985
Name:WALKUP, JERRY DON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:DON
Last Name:WALKUP
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2312 KNOB CREEK RD STE 208
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2367
Mailing Address - Country:US
Mailing Address - Phone:423-610-1099
Mailing Address - Fax:
Practice Address - Street 1:2312 KNOB CREEK RD STE 208
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2367
Practice Address - Country:US
Practice Address - Phone:423-610-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012562382080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty