Provider Demographics
NPI:1801935259
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:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CTRS
Authorized Official - Phone:912-681-3838
Mailing Address - Street 1:100 BRAMPTON AVE
Mailing Address - Street 2:STE 1F
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0827
Mailing Address - Country:US
Mailing Address - Phone:912-681-3838
Mailing Address - Fax:912-681-3839
Practice Address - Street 1:100 BRAMPTON AVE
Practice Address - Street 2:STE 1F
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0827
Practice Address - Country:US
Practice Address - Phone:912-681-3838
Practice Address - Fax:912-681-3839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPHRE0086653336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA0310930001Medicare ID - Type Unspecified