Provider Demographics
NPI:1750494134
Name:WALKER, GEORGE G
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:G
Last Name:WALKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WEST LAMPKIN ST
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759
Mailing Address - Country:US
Mailing Address - Phone:662-323-3941
Mailing Address - Fax:662-323-3942
Practice Address - Street 1:102 WEST LAMPKIN ST
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759
Practice Address - Country:US
Practice Address - Phone:662-323-3941
Practice Address - Fax:662-323-3942
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS05331207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00014220Medicaid
0909680001Medicare NSC
MSD00778Medicare UPIN
D00778Medicare UPIN
MS00014220Medicare ID - Type Unspecified
MS00014220Medicaid
NSC 0909680001Medicare PIN
0909680001Medicare PIN