Healthcare Provider Details

I. General information

NPI: 1801719109
Provider Name (Legal Business Name): CAITLYN DEANNA WALSH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 TEBEAU ST
WAYCROSS GA
31501-6357
US

IV. Provider business mailing address

5020 OLD RIVER RD
BLACKSHEAR GA
31516-4184
US

V. Phone/Fax

Practice location:
  • Phone: 912-283-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP261222
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberAPRN-NP261222
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: