Healthcare Provider Details

I. General information

NPI: 1427989052
Provider Name (Legal Business Name): AMBER WALKER WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2026
Last Update Date: 05/25/2026
Certification Date: 05/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4111 TAHOE CT
STONE MTN GA
30083-4453
US

IV. Provider business mailing address

4111 TAHOE CT
STONE MTN GA
30083-4453
US

V. Phone/Fax

Practice location:
  • Phone: 404-604-4391
  • Fax:
Mailing address:
  • Phone: 404-604-4391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT011714
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: