Provider Demographics
NPI:1851398366
Name:WALKER, CHARLES OSBORNE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:OSBORNE
Last Name:WALKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:804 N WILEY AVE
Mailing Address - Street 2:
Mailing Address - City:DONALSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:39845-1120
Mailing Address - Country:US
Mailing Address - Phone:229-524-2706
Mailing Address - Fax:229-524-2738
Practice Address - Street 1:804 N WILEY AVE
Practice Address - Street 2:
Practice Address - City:DONALSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:39845-1120
Practice Address - Country:US
Practice Address - Phone:229-524-2706
Practice Address - Fax:229-524-2738
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-10-06
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
GA009288208600000X
GA9288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000019324BMedicaid
GA581365608OtherCHARLES O WALKER MD PC
GA20-5308117OtherTHE WIREGRASS MEDICAL & S
GA000019324BMedicaid
GA20-5308117OtherTHE WIREGRASS MEDICAL & S
GAE00929Medicare UPIN