Provider Demographics
NPI:1255516993
Name:WALKER HOME MEDICAL
Entity type:Organization
Organization Name:WALKER HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSI
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-681-3838
Mailing Address - Street 1:206 NORTHSIDE DR W
Mailing Address - Street 2:STE 1
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4689
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:206 NORTHSIDE DR W
Practice Address - Street 2:STE 1
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4689
Practice Address - Country:US
Practice Address - Phone:912-681-3838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies