Individual
KENNETH GLEN WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
1296 SIMS ST, SUITE B, GAINESVILLE, GA 30501-3850
(770) 534-1856
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
034490
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660646B
—
GA
Enumeration date
08/30/2006
Last updated
07/21/2020
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