Provider Demographics
NPI:1780663567
Name:WALTERS, HENRY C JR (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:C
Last Name:WALTERS
Suffix:JR
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 1:1217 DAVIE AVE
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-3511
Mailing Address - Country:US
Mailing Address - Phone:704-372-2677
Mailing Address - Fax:704-660-4625
Practice Address - Street 1:1217 DAVIE AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3511
Practice Address - Country:US
Practice Address - Phone:704-372-2677
Practice Address - Fax:704-660-4625
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22859207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985531Medicaid
110133981Medicare PIN
NCC81076Medicare UPIN
NC8985531Medicaid