MEDICARE: CHARQUINTA WALKER LNMT

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	225700000X	Massage Therapist	MT010210	GA

General Provider Information

NPI Number	:	1285204180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARQUINTA WALKER LNMT

Provider Business Mailing Address
First Line	:	3863 HIGHWAY 138 SE STE 1080
Second Line	:
City	:	STOCKBRIDGE
State	:	GA
Zip	:	30281-4143
Country	:	US
Telephone Number	:	404-913-6924
Fax Number	:

Provider Business Practice Location Address
First Line	:	2321 ROLLING ROCK DR
Second Line	:
City	:	CONLEY
State	:	GA
Zip	:	30288-1464
Country	:	US
Telephone Number	:	404-333-7657
Fax Number	:

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

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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