Provider Demographics
NPI:1104163237
Name:WALTERS, NIA J (PHARMD)
Entity type:Individual
Prefix:
First Name:NIA
Middle Name:J
Last Name:WALTERS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6015 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:GA
Mailing Address - Zip Code:31008-6650
Mailing Address - Country:US
Mailing Address - Phone:478-953-2615
Mailing Address - Fax:478-971-0131
Practice Address - Street 1:6015 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:GA
Practice Address - Zip Code:31008-6650
Practice Address - Country:US
Practice Address - Phone:478-953-2615
Practice Address - Fax:478-971-0131
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022258183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist