Provider Demographics
NPI:1972219442
Name:WALLER, KACI (C-AA)
Entity type:Individual
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First Name:KACI
Middle Name:
Last Name:WALLER
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Gender:F
Credentials:C-AA
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Mailing Address - Street 1:2637 ARBOR GLEN PL
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4274
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2637 ARBOR GLEN PL
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4274
Practice Address - Country:US
Practice Address - Phone:229-589-7427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant