Provider Demographics
NPI:1962515635
Name:WALTON NURSING HOSPICE SERVICES INC
Entity type:Organization
Organization Name:WALTON NURSING HOSPICE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:770-222-6801
Mailing Address - Street 1:3401FLORENCE ROAD
Mailing Address - Street 2:200
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127
Mailing Address - Country:US
Mailing Address - Phone:770-222-6801
Mailing Address - Fax:770-222-6586
Practice Address - Street 1:3401 FLORENCE RD.
Practice Address - Street 2:SUITE 200
Practice Address - City:POWDER SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30127
Practice Address - Country:US
Practice Address - Phone:770-222-6801
Practice Address - Fax:770-222-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033190H251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111616Medicare ID - Type UnspecifiedHOSPICE