Healthcare Provider Details

I. General information

NPI: 1649117714
Provider Name (Legal Business Name): IVEY BURBRINK WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4500
US

IV. Provider business mailing address

2325 BROOKSTONE CENTRE PKWY
COLUMBUS GA
31904-4500
US

V. Phone/Fax

Practice location:
  • Phone: 706-653-6841
  • Fax: 706-653-7843
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY900349
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: