Provider Demographics
NPI:1962061226
Name:WALTON, MARIE LOUISE (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LOUISE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:DR
Other - First Name:MARIE
Other - Middle Name:LOUISE
Other - Last Name:PEHNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:3352 GLEN DEVON LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY LAKE
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6195
Mailing Address - Country:US
Mailing Address - Phone:404-642-7721
Mailing Address - Fax:
Practice Address - Street 1:113 UPPER RIVERDALE RD SW
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2540
Practice Address - Country:US
Practice Address - Phone:678-430-3232
Practice Address - Fax:678-321-0022
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47677261QR1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch