Provider Demographics
NPI:1255668406
Name:WALTON, LINDA (COTA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 SMOKE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3132
Mailing Address - Country:US
Mailing Address - Phone:470-387-0045
Mailing Address - Fax:
Practice Address - Street 1:7040 SMOKE RIDGE DR
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213
Practice Address - Country:US
Practice Address - Phone:470-387-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 376J00000X, 174N00000X, 372500000X, 372600000X, 374U00000X, 376K00000X, 374J00000X
WALA60164024224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No376J00000XNursing Service Related ProvidersHomemaker
No174N00000XOther Service ProvidersLactation Consultant, Non-RN
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion
No374U00000XNursing Service Related ProvidersHome Health Aide
No376K00000XNursing Service Related ProvidersNurse's Aide