Provider Demographics
NPI:1588876734
Name:WALKER, CORINNE M (DDS)
Entity type:Individual
Prefix:DR
First Name:CORINNE
Middle Name:M
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:P.O. BOX 2128
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-1374
Mailing Address - Country:US
Mailing Address - Phone:770-926-2500
Mailing Address - Fax:770-517-7911
Practice Address - Street 1:4595 TOWNE LAKE PARKWAY
Practice Address - Street 2:BUILDING 400 SUITE 150
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-6757
Practice Address - Country:US
Practice Address - Phone:770-926-2500
Practice Address - Fax:770-517-7911
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10525122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist