MEDICARE: ANGELA WALKER S/T

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	101YM0800X	Mental Health Counselor	0000000	GA

General Provider Information

NPI Number	:	1528444502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA WALKER S/T

Provider Business Mailing Address
First Line	:	PO BOX 1171
Second Line	:
City	:	MABLETON
State	:	GA
Zip	:	30126-1002
Country	:	US
Telephone Number	:	770-837-5441
Fax Number	:

Provider Business Practice Location Address
First Line	:	7104 PEACHTREE CREEK CIR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30341-5371
Country	:	US
Telephone Number	:	770-837-5441
Fax Number	:

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

Provider Enumeration Date	:	07/31/2015
Last Update Date	:	07/31/2015

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