Individual
WALTER KENNETH AUSTIN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
175 SAMARITAN DR, JASPER, GA 30143-1964
(706) 253-4633
(706) 253-1192
Mailing address
175 SAMARITAN DR STE 100, JASPER, GA 30143-1964
(706) 253-4633
(706) 253-1192
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
047049
GA
207RC0000X
Cardiovascular Disease Physician
047049
GA
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
047049
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000818639DEG
—
GA
Enumeration date
06/14/2005
Last updated
09/04/2025
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