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General NPI Number Information
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NPI Number | 1962061226
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Entity Type | Individual
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Provider Name | MARIE LOUISE WALTON MD, MPH
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Gender | Female
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Dates
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Enumeration Date | 06/11/2019
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Last Update Date | 05/11/2021
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Provider Practice Location Address
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Address Line | 113 UPPER RIVERDALE RD SW
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City | RIVERDALE
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State | GA
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Zip | 30274-2540
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Country | US
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Telephone | 678-430-3232
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Fax | 678-321-0022
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Provider Business Mailing Address
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Address Line | 3352 GLEN DEVON LN
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City | BERKELEY LAKE
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State | GA
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Zip | 30096-6195
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Country | US
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Telephone | 404-642-7721
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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 | 261QR1100X
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Taxonomy Name | Research Clinic/Center
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License Number | 47677
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License Number State | GA
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