Healthcare Provider Details

I. General information

NPI: 1598513525
Provider Name (Legal Business Name): CHYNA WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHYNA BELLAMY

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 S MAIN ST
BAXLEY GA
31513-0102
US

IV. Provider business mailing address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8618
US

V. Phone/Fax

Practice location:
  • Phone: 229-444-3166
  • Fax: 229-444-3166
Mailing address:
  • Phone: 904-886-3228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88356
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: