Individual
MRS. DONNA VAN BLADEL WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
144 BILL CARRUTH PKWY STE 3100, HIRAM, GA 30141-3819
(678) 363-1940
(678) 581-7110
Mailing address
531 ROSELANE ST NW STE 710, MARIETTA, GA 30060-6975
(678) 331-3297
(678) 581-7187
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN-NP134321
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184603045
NPI NUMBER
GA
Enumeration date
01/10/2006
Last updated
10/20/2025
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