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Individual

AUDREA DESHON WALKER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MASSAGE THERPAIST

Contact information

Practice address
3115 PIEDMONT RD NE STE D102, ATLANTA, GA 30305-2521
(404) 969-2374
Mailing address
6425 OAKLEY RD APT 1507, UNION CITY, GA 30291-1582
(678) 754-7972

Taxonomy

Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MT000792
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MT000792
NO OTHER NUMBERS
GA
Enumeration date
11/14/2019
Last updated
11/14/2019
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