Individual
URSULA F WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
128 MARSHALL RD, BUCKHEAD, GA 30625-2906
(706) 473-6192
(706) 485-9254
Mailing address
128 MARSHALL RD, BUCKHEAD, GA 30625-2906
(706) 473-6192
(706) 485-9254
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1540540
GA
367500000X
Certified Registered Nurse Anesthetist
9299664
FL
367500000X
Certified Registered Nurse Anesthetist
COA.17161-NA
OH
Other
Enumeration date
06/04/2014
Last updated
05/27/2016
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