Healthcare Provider Details

I. General information

NPI: 1962349746
Provider Name (Legal Business Name): TEQUILA WALKER CNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11340 LAKEFIELD DR STE 200
JOHNS CREEK GA
30097-2456
US

IV. Provider business mailing address

11340 LAKEFIELD DR STE 200
JOHNS CREEK GA
30097-2456
US

V. Phone/Fax

Practice location:
  • Phone: 678-775-1211
  • Fax: 770-929-6411
Mailing address:
  • Phone: 678-775-1211
  • Fax: 770-929-6411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCN0000034303
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: