Healthcare Provider Details

I. General information

NPI: 1346762895
Provider Name (Legal Business Name): MONICA WALKER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2017
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 PRESTON CREEK DR
MCDONOUGH GA
30253-8976
US

IV. Provider business mailing address

1023 PRESTON CREEK DR
MCDONOUGH GA
30253-8976
US

V. Phone/Fax

Practice location:
  • Phone: 937-305-1156
  • Fax:
Mailing address:
  • Phone: 229-374-9776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number092930
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: