Healthcare Provider Details

I. General information

NPI: 1841164951
Provider Name (Legal Business Name): CAMERON ANN WALDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 MERCER UNIVERSITY DR
ATLANTA GA
30341-4115
US

IV. Provider business mailing address

2037 WEEMS RD APT 10112
TUCKER GA
30084-5319
US

V. Phone/Fax

Practice location:
  • Phone: 800-637-2378
  • Fax:
Mailing address:
  • Phone: 762-207-7359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN316902
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: