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Paul Lance Walker

Family Medicine

Allopathic & Osteopathic Physicians

1810 White Cir, Suite 155, Marietta, GA 30066-5835

(877) 613-1990

PECOS Enrollment

This provider is enrolled in PECOS as PAUL WALKER.

Based on the most recent information from CMS, provider Paul Lance Walker is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records yesterday at 11:47 AM.

Profile Details

Provider ID
1356438097
Provider Type
Individual
Full Name
Walker, Paul Lance
Credential
DO

Gender
Male
Sole Proprietor
No
Enumeration Date
10/6/2006
Last Updated
9/21/2011

Contact Information

Practice Location

1810 White Cir, Suite 155, Marietta, GA 30066-5835

(877) 613-1990

Unlisted Fax

Mailing Location

1810 White Cir, Suite 155, Marietta, GA 30066-5835

(877) 613-1990

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 207Q00000X Primary	Description Family Medicine Allopathic & Osteopathic Physicians	License 046272 Georgia

Provider Identifiers

ID	Description	Issuer
ID 000804218E	Description Medicaid	Issuer Unlisted Georgia

Paul Lance Walker

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Mitchell, Kyle Darren

Meredith, Catherine M

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Bullington, Karen Patricia

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