Individual
JACKQUELINE WALKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
175 GWINNETT DR, LAWRENCEVILLE, GA 30046-8444
(678) 209-2394
Mailing address
130 AVERY DR, COVINGTON, GA 30016-8520
(770) 203-5915
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN090490
GA
Other
Enumeration date
05/18/2021
Last updated
05/18/2021
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