Provider Demographics
NPI:1700962644
Name:CARTER, WALKER GRADY III (MD)
Entity Type:Individual
Prefix:
First Name:WALKER
Middle Name:GRADY
Last Name:CARTER
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31217-3838
Mailing Address - Country:US
Mailing Address - Phone:478-301-5930
Mailing Address - Fax:866-508-6866
Practice Address - Street 1:340 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31217-3838
Practice Address - Country:US
Practice Address - Phone:478-301-5930
Practice Address - Fax:866-508-6866
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0460582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000906958AMedicaid
GA260047816OtherRAILROAD MEDICARE
H37079Medicare UPIN
GA260047816OtherRAILROAD MEDICARE
26BDHPPMedicare ID - Type Unspecified