Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD426466 | PA |
Y | 2080P0203X | Pediatric Critical Care Doctor | 061015 | GA |
NPI | 1043491483 |
---|---|
Provider Name | Karen Hallermeier Walson |
First Address | Decatur, GA 30030-3771 |
Second Address | Atlanta, GA 30328-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2007 |
Last Update Date | 18/08/2008 |