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NPI Code Detail

MEDICARE: MRS. DONNA VAN BLADEL WALL NP

MEDICARE: MRS. DONNA VAN BLADEL WALL NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerAPRN-NP134321GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11184603045OTHERGANPI NUMBER

General Provider Information

NPI Number : 1184603045
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DONNA VAN BLADEL WALL NP
Provider Business Mailing Address
First Line : 531 ROSELANE ST NW STE 710
Second Line :
City : MARIETTA
State : GA
Zip : 30060-6975
Country : US
Telephone Number : 678-331-3297
Fax Number : 678-581-7187
Provider Business Practice Location Address
First Line : 144 BILL CARRUTH PKWY STE 3100
Second Line :
City : HIRAM
State : GA
Zip : 30141-3819
Country : US
Telephone Number : 678-363-1940
Fax Number : 678-581-7110
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2006
Last Update Date : 10/20/2025

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