Healthcare Provider Details

I. General information

NPI: 1508993924
Provider Name (Legal Business Name): GENA J MARKWALTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENA LYNN MARKWALTER RN

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 10/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3647 J DEWEY GRAY CIR STE 200
AUGUSTA GA
30909-2205
US

IV. Provider business mailing address

PO BOX 3548
AUGUSTA GA
30914-3548
US

V. Phone/Fax

Practice location:
  • Phone: 706-504-9712
  • Fax: 706-504-9703
Mailing address:
  • Phone: 706-863-9595
  • Fax: 706-868-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN129040
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberRN129040
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: