Basic Information
| Provider Information | |||||||||
| NPI: | 1053336313 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BUTLER | ||||||||
| FirstName: | WALTER | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1984 PEACHTREE RD NW | ||||||||
| Address2: | STE 515 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303095219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043511745 | ||||||||
| FaxNumber: | 4043517121 | ||||||||
| Practice Location | |||||||||
| Address1: | 1640 AIRPORT RD NW | ||||||||
| Address2: | STE 110 | ||||||||
| City: | KENNESAW | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301447038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782022074 | ||||||||
| FaxNumber: | 7705901442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 009102 | GA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0008653 | 05 | GA | MEDICAID |