Healthcare Provider Details

I. General information

NPI: 1073129581
Provider Name (Legal Business Name): AMANDA WALTER MSN, APRN, AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 JOHNSON FY RD NE
ATLANTA GA
30342-1611
US

IV. Provider business mailing address

4135 ARCH PASS
CUMMING GA
30040-9377
US

V. Phone/Fax

Practice location:
  • Phone: 404-851-6123
  • Fax:
Mailing address:
  • Phone: 239-304-6290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN228817
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN228817
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberRN228817
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: