Provider Demographics
NPI:1659927408
Name:WALKER, CORINE GODFREY
Entity Type:Individual
Prefix:MS
First Name:CORINE
Middle Name:GODFREY
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-8305
Mailing Address - Country:US
Mailing Address - Phone:229-891-1019
Mailing Address - Fax:
Practice Address - Street 1:1364 TUCKER RD
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-8305
Practice Address - Country:US
Practice Address - Phone:229-891-1019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator