Provider Demographics
NPI:1639174840
Name:MASHMAN, WALTER EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:EDWARD
Last Name:MASHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1709
Mailing Address - Country:US
Mailing Address - Phone:404-605-2800
Mailing Address - Fax:404-251-5983
Practice Address - Street 1:275 COLLIER RD NW
Practice Address - Street 2:STE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1709
Practice Address - Country:US
Practice Address - Phone:404-605-2800
Practice Address - Fax:404-251-5983
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2010-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA032956207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000546499QRTMedicaid
GA000546499QRTMedicaid
GA202I061119Medicare PIN