Healthcare Provider Details

I. General information

NPI: 1871404178
Provider Name (Legal Business Name): SHALAE WALKER CPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 PIEDMONT AVE NE APT 904
ATLANTA GA
30308-3437
US

IV. Provider business mailing address

450 PIEDMONT AVE NE APT 904
ATLANTA GA
30308-3437
US

V. Phone/Fax

Practice location:
  • Phone: 404-944-9948
  • Fax:
Mailing address:
  • Phone: 404-944-9948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberK2Y6Q7L9
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: