Provider Demographics
NPI:1700088325
Name:TATUM WALKER, SHELLEY BARTON (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:BARTON
Last Name:TATUM WALKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:BARTON
Other - Middle Name:T
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:597 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:PRATTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36067-3630
Mailing Address - Country:US
Mailing Address - Phone:334-365-9732
Mailing Address - Fax:
Practice Address - Street 1:597 SOUTH MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PRATTVILLE
Practice Address - State:AL
Practice Address - Zip Code:36066
Practice Address - Country:US
Practice Address - Phone:334-365-9732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice