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General NPI Number Information
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NPI Number | 1891303913
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Entity Type | Individual
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Provider Name | COURTNEY WALKER COA
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Gender | Female
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Dates
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Enumeration Date | 07/14/2020
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Last Update Date | 07/14/2020
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Provider Practice Location Address
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Address Line | 132 STANLEY CT STE M
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-9061
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Country | US
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Telephone | 470-242-4733
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Fax | 866-398-5005
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Provider Business Mailing Address
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Address Line | 3475 MORGAN RD
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City | BUFORD
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State | GA
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Zip | 30519-5504
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Country | US
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Telephone | 470-242-4733
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Fax | 866-398-5005
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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 | 156FX1101X
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Taxonomy Name | Ophthalmic Assistant
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License Number | 180309
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License Number State | GA
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