Healthcare Provider Details

I. General information

NPI: 1235538877
Provider Name (Legal Business Name): LINDSAY WHITE WALSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 08/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 CLIFTON RD NE STE 312
ATLANTA GA
30322-1000
US

IV. Provider business mailing address

1462 CLIFTON RD NE STE 312
ATLANTA GA
30322-1000
US

V. Phone/Fax

Practice location:
  • Phone: 404-712-5660
  • Fax:
Mailing address:
  • Phone: 404-712-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT011587
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: