Provider Demographics
NPI:1972833564
Name:WALTER F. ANDERSON, MD, PC
Entity Type:Organization
Organization Name:WALTER F. ANDERSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:FAUST
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-936-9403
Mailing Address - Street 1:4675 N SHALLOWFORD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6309
Mailing Address - Country:US
Mailing Address - Phone:770-936-9403
Mailing Address - Fax:770-936-9474
Practice Address - Street 1:4675 N SHALLOWFORD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30338-6309
Practice Address - Country:US
Practice Address - Phone:770-936-9403
Practice Address - Fax:770-936-9474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-05
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0219392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty