Provider Demographics
NPI:1659068849
Name:MCGARY, WALTER LEE JR (BS PP)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:LEE
Last Name:MCGARY
Suffix:JR
Gender:M
Credentials:BS PP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CROSBYTOWN RD
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-5866
Mailing Address - Country:US
Mailing Address - Phone:404-386-8282
Mailing Address - Fax:
Practice Address - Street 1:195 CROSBYTOWN RD
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-5866
Practice Address - Country:US
Practice Address - Phone:404-386-8282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator