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General NPI Number Information
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NPI Number | 1750861217
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Entity Type | Individual
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Provider Name | LATRINA S WALDEN FNP-C
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Gender | Female
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 10/29/2025
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Provider Practice Location Address
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Address Line | 4045 FIVE FORKS TRICKUM RD SW STE 130
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City | LILBURN
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State | GA
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Zip | 30047-2538
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Country | US
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Telephone | 404-860-2425
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Fax | 678-737-1726
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Provider Business Mailing Address
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Address Line | 887 RYAN LN SW
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City | LILBURN
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State | GA
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Zip | 30047-6642
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Country | US
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Telephone |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 214211
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 214211
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License Number State | GA
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