Provider Demographics
NPI:1164987681
Name:WALTON, MONICA
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7559 EMERALD GREENS DR N
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-5792
Mailing Address - Country:US
Mailing Address - Phone:601-540-1441
Mailing Address - Fax:
Practice Address - Street 1:7559 EMERALD GREENS DR N
Practice Address - Street 2:
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-5792
Practice Address - Country:US
Practice Address - Phone:601-540-1441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty