Provider Demographics
NPI:1841393188
Name:FALCONER, WALTER Z (MD)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:Z
Last Name:FALCONER
Suffix:
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 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:2685 MILSCOTT DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-5906
Practice Address - Country:US
Practice Address - Phone:404-292-3727
Practice Address - Fax:404-294-9674
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035252208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00046332OtherRAILROAD MEDICARE
GA000502851AMedicaid
GA000502851AMedicaid
GA34BDDKGMedicare PIN
GA000502851AMedicaid