Provider Demographics
NPI:1154543973
Name:WALKER, ESEOSA GUOBADIA (DPT)
Entity type:Individual
Prefix:DR
First Name:ESEOSA
Middle Name:GUOBADIA
Last Name:WALKER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 BRASELTON HWY
Mailing Address - Street 2:SUITE 10-293
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019
Mailing Address - Country:US
Mailing Address - Phone:516-782-5331
Mailing Address - Fax:
Practice Address - Street 1:1585 OLD NORCROSS RD STE 201B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4054
Practice Address - Country:US
Practice Address - Phone:404-487-8491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT011817225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist