Provider Demographics
NPI:1720109853
Name:WALRATH, JOSEPH D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:D
Last Name:WALRATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3200 DOWNWOOD CIR NW
Mailing Address - Street 2:640
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-1610
Mailing Address - Country:US
Mailing Address - Phone:404-351-0051
Mailing Address - Fax:404-351-0632
Practice Address - Street 1:3200 DOWNWOOD CIR NW
Practice Address - Street 2:640
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-1610
Practice Address - Country:US
Practice Address - Phone:404-351-0051
Practice Address - Fax:404-351-0632
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2017-11-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA060514207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02912921Medicaid