Healthcare Provider Details

I. General information

NPI: 1073443990
Provider Name (Legal Business Name): BETHANY HEATH WALKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 INDUSTRIAL BLVD
DUBLIN GA
31021-2981
US

IV. Provider business mailing address

2494 HURST RD
TENNILLE GA
31089-2105
US

V. Phone/Fax

Practice location:
  • Phone: 478-275-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN291592
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: