Provider Demographics
NPI:1982877536
Name:WALKER WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:WALKER WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:CRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-384-4348
Mailing Address - Street 1:306 OAKHILL RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35504-7465
Mailing Address - Country:US
Mailing Address - Phone:205-384-4348
Mailing Address - Fax:205-384-4323
Practice Address - Street 1:306 OAKHILL RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35504-7465
Practice Address - Country:US
Practice Address - Phone:205-384-4348
Practice Address - Fax:205-384-4323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913343Medicaid
AL51007115OtherBCBS
AL510G700171Medicare PIN