Healthcare Provider Details

I. General information

NPI: 1053584722
Provider Name (Legal Business Name): SNAPFINGER WOODS FAMILY PRACTICE GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2008
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5071 SNAPFINGER WOODS DR
DECATUR GA
30035-4019
US

IV. Provider business mailing address

5071 SNAPFINGER WOODS DR
DECATUR GA
30035-4019
US

V. Phone/Fax

Practice location:
  • Phone: 770-981-0600
  • Fax: 770-981-0677
Mailing address:
  • Phone: 770-981-0600
  • Fax: 770-981-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number025306
License Number StateGA

VIII. Authorized Official

Name: DR. MARIA LATANYA WALKER
Title or Position: CEO
Credential:
Phone: 770-981-0600