Healthcare Provider Details

I. General information

NPI: 1447038252
Provider Name (Legal Business Name): YOUJIN WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 SATELLITE BLVD NW STE 701A
SUWANEE GA
30024-4676
US

IV. Provider business mailing address

1848 AUTUMN SAGE DR
DACULA GA
30019-7280
US

V. Phone/Fax

Practice location:
  • Phone: 470-230-0301
  • Fax:
Mailing address:
  • Phone: 470-230-0301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN248923
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN248923
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: