Provider Demographics
NPI:1932218138
Name:WALKER, SUE D (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-579-5261
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:421 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7236
Practice Address - Country:US
Practice Address - Phone:601-579-5261
Practice Address - Fax:601-579-5257
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12894207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1561282Medicaid
AL009924650Medicaid
MS00116241Medicaid
MS1559125OtherAMERICAN ADMIN GROUP
AL009924650Medicaid
MS1559125OtherAMERICAN ADMIN GROUP
AL009924650Medicaid