Healthcare Provider Details

I. General information

NPI: 1700582103
Provider Name (Legal Business Name): ALLEGRA RENEE CREWS WALKER MSN APRN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2023
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE
ATLANTA GA
30308-2212
US

IV. Provider business mailing address

1520 ROGERS AVE SW
ATLANTA GA
30310-2306
US

V. Phone/Fax

Practice location:
  • Phone: 319-850-7085
  • Fax:
Mailing address:
  • Phone: 319-850-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: