Individual
DR. GORDON LESLIE WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
818 SAINT SEBASTIAN WAY, SUITE 311, AUGUSTA, GA 30901-2651
(706) 724-3473
(706) 724-3493
Mailing address
PO BOX 925, AUGUSTA, GA 30903-0925
(706) 724-3473
(706) 724-3493
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
030919
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000385602A
—
GA
01
—
024281
BCBS
GA
05
—
G30919
—
SC
Enumeration date
11/18/2005
Last updated
06/24/2020
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