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General NPI Number Information
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NPI Number | 1326480666
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Entity Type | Organization
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Legal Business Name | CONYERS WALK IN CLINIC
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 1804 OVER LAKE DR SE
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City | CONYERS
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State | GA
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Zip | 30013-1788
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Country | US
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Telephone | 770-679-9935
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Fax | 770-679-9938
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Provider Business Mailing Address
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Address Line | 1804 OVER LAKE DR SE STE A
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City | CONYERS
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State | GA
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Zip | 30013-1788
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Country | US
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Telephone | 770-679-9935
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Fax | 770-679-9938
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Authorized Official
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Title or Position | OWNER/NURSE PRACTITIONER
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Name | DANIELLE NICOLE WATERS
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Credential | FNP
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Telephone | 770-679-9935
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN206177
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 206177
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License Number State | GA
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