Provider Demographics
NPI:1447039995
Name:WALRATH, PAUL SCOTT (CSFA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:SCOTT
Last Name:WALRATH
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HELEN LN
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:GA
Mailing Address - Zip Code:31811-3511
Mailing Address - Country:US
Mailing Address - Phone:334-614-0729
Mailing Address - Fax:
Practice Address - Street 1:425 HELEN LN
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:GA
Practice Address - Zip Code:31811-3511
Practice Address - Country:US
Practice Address - Phone:334-614-0729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant