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General NPI Number Information
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NPI Number | 1073104022
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Entity Type | Individual
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Provider Name | YVONNE ROSE WALCOTT PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/02/2021
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 173 BOLEVARD NE
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City | ATLANTA
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State | GA
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Zip | 30312
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Country | US
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Telephone | 404-815-1181
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Fax |
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Provider Business Mailing Address
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Address Line | 500 TAMMANY POINTE
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City | ALPHARETTA
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State | GA
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Zip | 30004-4208
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Country | US
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Telephone | 404-452-1403
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 121950
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License Number State | GA
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