Provider Demographics
NPI:1720380843
Name:WALTERS, ANTHONY JOSEPH (CLINICAL SOCIAL WORK)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:JOSEPH
Last Name:WALTERS
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Gender:M
Credentials:CLINICAL SOCIAL WORK
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Mailing Address - Street 1:515B CITY BOULEVARD
Mailing Address - Street 2:WAYCROSS RURAL INITATIVE CLINIC
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-8016
Mailing Address - Country:US
Mailing Address - Phone:912-279-4400
Mailing Address - Fax:912-279-4448
Practice Address - Street 1:515B CITY BOULEVARD
Practice Address - Street 2:WAYCROSS VA OUTREACH CLINIC
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-8016
Practice Address - Country:US
Practice Address - Phone:912-279-4400
Practice Address - Fax:912-279-4448
Is Sole Proprietor?:No
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GACSW0042491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical