Provider Demographics
NPI:1629033899
Name:WALKER, BEVERLY DIANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:DIANNE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 W 2ND AVE
Mailing Address - Street 2:PO BOX 70369
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31701-2369
Mailing Address - Country:US
Mailing Address - Phone:229-883-0537
Mailing Address - Fax:229-883-8831
Practice Address - Street 1:311 W 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31701-2369
Practice Address - Country:US
Practice Address - Phone:229-883-0537
Practice Address - Fax:229-883-8831
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA203952080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00178681AMedicaid
GA20395OtherMEDICAL LICENSE NO
GA20395OtherMEDICAL LICENSE NO
GA20395OtherMEDICAL LICENSE NO
GA20395OtherMEDICAL LICENSE NO