Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 68961 | GA |
Y | 2080P0204X | Pediatric Emergency Doctor | A75502 | CA |
NPI | 1093888588 |
---|---|
Provider Name | Maia Alees Walton |
First Address | Alpharetta, GA 30005-8771 |
Second Address | Alpharetta, GA 30005-8771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 26/01/2017 |