Provider Demographics
NPI:1851419816
Name:WALTON, GRACE JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE
Middle Name:JOY
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 W BROAD ST LOWR LEVEL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1648
Mailing Address - Country:US
Mailing Address - Phone:614-544-1976
Mailing Address - Fax:614-544-1981
Practice Address - Street 1:5109 W BROAD ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1648
Practice Address - Country:US
Practice Address - Phone:614-544-1976
Practice Address - Fax:614-544-1981
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-120935208000000X, 207R00000X
OH35.1209352080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0823685Medicaid