Provider Demographics
NPI:1144491119
Name:WALKER, SHARIFA WINBUSH (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARIFA
Middle Name:WINBUSH
Last Name:WALKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2542 OVERLAKE LN
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5240
Mailing Address - Country:US
Mailing Address - Phone:901-590-6440
Mailing Address - Fax:
Practice Address - Street 1:127 E. TRINITY PLACE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1111
Practice Address - Country:US
Practice Address - Phone:404-446-2776
Practice Address - Fax:404-446-2777
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-18
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8075122300000X
GADN013632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN9184072Medicaid