Healthcare Provider Details

I. General information

NPI: 1326480666
Provider Name (Legal Business Name): CONYERS WALK IN CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2013
Last Update Date: 10/07/2025
Certification Date: 10/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 OVER LAKE DR SE
CONYERS GA
30013-1788
US

IV. Provider business mailing address

1804 OVER LAKE DR SE STE A
CONYERS GA
30013-1788
US

V. Phone/Fax

Practice location:
  • Phone: 770-679-9935
  • Fax: 770-679-9938
Mailing address:
  • Phone: 770-679-9935
  • Fax: 770-679-9938

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number206177
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN206177
License Number StateGA

VIII. Authorized Official

Name: DANIELLE NICOLE WATERS
Title or Position: OWNER/NURSE PRACTITIONER
Credential: FNP
Phone: 770-679-9935