MEDICARE: ERIKA KAREN WALLENDER

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
1	207RI0200X	Infectious Disease Physician	91927	GA

General Provider Information

NPI Number	:	1215294517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIKA KAREN WALLENDER

Provider Business Mailing Address
First Line	:	266 ORMOND ST SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-1357
Country	:	US
Telephone Number	:	510-847-5036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2665 N DECATUR RD STE 330
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-6145
Country	:	US
Telephone Number	:	404-297-9755
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/02/2024

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