Individual
MS. STACEY DIANE WALTERS
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1500 N PATTERSON ST, DEPT. KPE, VALDOSTA, GA 31698-0100
(229) 293-6071
Mailing address
272 RIDGELAND DR, VALDOSTA, GA 31602-7845
(229) 263-9071
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AT001138
GA
Other
Enumeration date
02/08/2006
Last updated
07/08/2007
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