Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | RN054676 | GA |
NPI | 1003082363 |
---|---|
Provider Name | Sheila Reece Walls |
First Address | Carrollton, GA 30117-3874 |
Second Address | Carrollton, GA 30117-3874 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2008 |
Last Update Date | 06/05/2008 |