Healthcare Provider Details

I. General information

NPI: 1215969522
Provider Name (Legal Business Name): MARY EMILY WALKER I R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 SHYREWOOD DR
LAWRENCEVILLE GA
30043-6452
US

IV. Provider business mailing address

421 SHYREWOOD DR
LAWRENCEVILLE GA
30043-6452
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-6111
  • Fax:
Mailing address:
  • Phone: 404-321-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN055065
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: