MEDICARE: DR. JACQUELINE MACHE WALTERS M.D.

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	207V00000X	Obstetrics & Gynecology Physician	040275	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	GRP3569	OTHER	GA	OPTOUT

General Provider Information

NPI Number	:	1285628891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACQUELINE MACHE WALTERS M.D.

Provider Business Mailing Address
First Line	:	5780 PEACHTREE DUNWOODY RD STE 300
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1513
Country	:	US
Telephone Number	:	404-303-1224
Fax Number	:	404-303-1325

Provider Business Practice Location Address
First Line	:	3630 SAVANNAH PL STE 100
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-5028
Country	:	US
Telephone Number	:	678-474-0203
Fax Number	:	678-474-0207

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/30/2018

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