Healthcare Provider Details

I. General information

NPI: 1659693885
Provider Name (Legal Business Name): .NADINE VICTORIA WALKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4924 HAMLET CT
LITHONIA GA
30038-2205
US

IV. Provider business mailing address

4402 15TH ST NW
WASHINGTON DC
20011-7024
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-3265
  • Fax:
Mailing address:
  • Phone: 202-723-3265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20617
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20617
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number20617
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number20617
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number20617
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20617
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number20617
License Number StateGA
# 8
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number20617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: