MEDICARE: RELISHA NICOLE WALTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1851255475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RELISHA NICOLE WALTON

Provider Business Mailing Address
First Line	:	320 LANIER AVE W STE 200
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30214-7443
Country	:	US
Telephone Number	:	404-947-8303
Fax Number	:

Provider Business Practice Location Address
First Line	:	4166 SNAPFINGER WOODS DR
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30035-3411
Country	:	US
Telephone Number	:	404-947-8303
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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Directions to “ RELISHA NICOLE WALTON ” Practice Location

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