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Individual

KENNETH BRIAN WALTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1497 FAIR RD STE 200, STATESBORO, GA 30458-0824
(912) 871-7100
(912) 871-7110
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7211
(615) 628-6877

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
065436
GA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
065436
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
003107922A
GA
01
014459259
AMERIGROUP
GA
01
52343669
BCBS
GA
01
626252
WELLCARE
GA
01
P01108293
RAILROAD MEDICARE
GA
Enumeration date
06/15/2006
Last updated
02/09/2026
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