Provider Demographics
NPI:1720189475
Name:WALKER, KENNETH JAMES (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:WALKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6392
Mailing Address - Country:US
Mailing Address - Phone:478-971-2500
Mailing Address - Fax:478-971-2503
Practice Address - Street 1:300 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6392
Practice Address - Country:US
Practice Address - Phone:478-971-2500
Practice Address - Fax:478-971-2503
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031853207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00403763BMedicaid
GA00403763BMedicaid
04BDBKKMedicare ID - Type Unspecified