Healthcare Provider Details

I. General information

NPI: 1558822197
Provider Name (Legal Business Name): LILY ANN WALSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE BLDG B
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1365 CLIFTON RD NE BLDG B
ATLANTA GA
30322-1013
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-8570
  • Fax:
Mailing address:
  • Phone: 404-778-8570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number109385
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: