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General NPI Number Information
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NPI Number | 1013078062
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Entity Type | Individual
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Provider Name | LATISHA JONES WALKER M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 977 TAYLOR ST SW # A
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City | CONYERS
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State | GA
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Zip | 30012-5357
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Country | US
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Telephone | 770-918-6677
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Fax | 770-918-6686
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Provider Business Mailing Address
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Address Line | 30 GOLDFINCH DR
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City | COVINGTON
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State | GA
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Zip | 30016-9057
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Country | US
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Telephone | 678-625-4331
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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