Randy P Walters, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

149 Issued in AL

Practice address

632 W Front St N
Thomasville, AL 36784-5316

Phone

(334) 636-2713

Fax

(334) 636-2711

NPI assigned

Sep 25, 2006

Last updated

Oct 20, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Randy P Walters, DMD, PC

  • Dentist
  • Thomasville, AL
  • NPI 1437274891
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1255996800000",
    "number": "1861592081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "632 W FRONT ST N",
            "city": "THOMASVILLE",
            "state": "AL",
            "postal_code": "367845316",
            "telephone_number": "334-636-2713",
            "fax_number": "334-636-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "632 W FRONT ST N",
            "city": "THOMASVILLE",
            "state": "AL",
            "postal_code": "367845316",
            "telephone_number": "334-636-2713",
            "fax_number": "334-636-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "RANDY",
        "middle_name": "P",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2009-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009943710",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Earnestine Wagner, CRNP
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1174)
• Wal-Mart Stores East, LP (Vision Center 30-1174)
• Walgreen Co (Rite Aid)
• Walgreen Co (Walgreens #11115)
• Whitaker Drugs Thomasville LLC (Family Medicine Pharmacy)
• Barbara Ellen Wilson, RPH,MBA
• Gary Mark Wise, RPH

• Dentist in Thomasville, AL
• Providers in Thomasville, AL by specialty
• Dentist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.