Provider Demographics
NPI:1184826638
Name:WALTER, SUSAN WHEELER (APRN,BC)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:WHEELER
Last Name:WALTER
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 GRAEFE ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4222
Mailing Address - Country:US
Mailing Address - Phone:770-227-1587
Mailing Address - Fax:770-227-1485
Practice Address - Street 1:231 GRAEFE ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4222
Practice Address - Country:US
Practice Address - Phone:770-227-1587
Practice Address - Fax:770-227-1485
Is Sole Proprietor?:No
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN078025363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner