Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | RN044181 | GA |
NPI | 1003139510 |
---|---|
Provider Name | Jewell Allen Walker |
First Address | Riverdale, GA 30274 |
Second Address | Riverdale, GA 30274 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2010 |
Last Update Date | 11/03/2010 |