Individual
BILLY WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
903 MISSISSIPPI DR, TUPELO, MS 38804-0928
(662) 377-4652
(662) 377-4656
Mailing address
450 E PRESIDENT AVE, TUPELO, MS 38801-5599
(662) 377-4685
(662) 377-2755
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
12216
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00115083
—
MS
Enumeration date
04/26/2006
Last updated
04/09/2009
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