Provider Demographics
NPI:1184007742
Name:CHARLES A. WALKER DBA WALKER PAIN MANAGEMENT CENTERS
Entity type:Organization
Organization Name:CHARLES A. WALKER DBA WALKER PAIN MANAGEMENT CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:731-644-0144
Mailing Address - Street 1:707 E WOOD ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TN
Mailing Address - Zip Code:38242-4221
Mailing Address - Country:US
Mailing Address - Phone:731-644-0144
Mailing Address - Fax:731-644-0887
Practice Address - Street 1:707 E WOOD ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TN
Practice Address - Zip Code:38242-4221
Practice Address - Country:US
Practice Address - Phone:731-644-0144
Practice Address - Fax:731-644-0887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN17178174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty