Healthcare Provider Details

I. General information

NPI: 1093423410
Provider Name (Legal Business Name): PATINA SHARESE WALTON-BATTLE DNP APRN FNP-C PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2022
Last Update Date: 11/14/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 GARY HILL RD
EDGEFIELD SC
29824-4503
US

IV. Provider business mailing address

5050 SUSSEX DR
EVANS GA
30809-8231
US

V. Phone/Fax

Practice location:
  • Phone: 803-637-1500
  • Fax:
Mailing address:
  • Phone: 404-735-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17594
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: