Healthcare Provider Details

I. General information

NPI: 1700731551
Provider Name (Legal Business Name): ANGELA WALKER MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 CRYSTAL SPRINGS TRL
HAMPTON GA
30228-2651
US

IV. Provider business mailing address

12230 STILLMAN CT
HAMPTON GA
30228-3500
US

V. Phone/Fax

Practice location:
  • Phone: 770-342-8827
  • Fax:
Mailing address:
  • Phone: 770-342-8827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN311568
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: