Provider Demographics
NPI:1538603220
Name:WALKER, NINA MARIE
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:MARIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 LAUREL CREEK CT SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6591
Mailing Address - Country:US
Mailing Address - Phone:678-770-4532
Mailing Address - Fax:
Practice Address - Street 1:1025 E WEST CONNECTOR
Practice Address - Street 2:STE. 340
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8513
Practice Address - Country:US
Practice Address - Phone:678-259-9298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOCC0077311744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management