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Individual

DR. PHILLIP GENE WALTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3995 COVINGTON HWY, DECATUR, GA 30032-2645
(404) 284-6911
(404) 288-4165
Mailing address
3995 COVINGTON HWY, DECATUR, GA 30032-2645
(404) 284-6911
(404) 288-4165

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN008971
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00213056A
GA
01
9180345
AMERIGROUP MEDICADE
GA
Enumeration date
06/21/2006
Last updated
10/18/2012
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