Healthcare Provider Details

I. General information

NPI: 1003139510
Provider Name (Legal Business Name): JEWELL ALLEN WALKER WHNP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2010
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 UPPER RIVERDALE ROAD BLDG 2 SUITE 135
RIVERDALE GA
30274
US

IV. Provider business mailing address

83 UPPER RIVERDALE ROAD BLDG 2 SUITE 135
RIVERDALE GA
30274
US

V. Phone/Fax

Practice location:
  • Phone: 770-991-0778
  • Fax:
Mailing address:
  • Phone: 770-991-0778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SW0102X
TaxonomyWomen's Health Clinical Nurse Specialist
License NumberRN044181
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN044181
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: