Provider Demographics
NPI:1275895963
Name:WALKER, LA TOSHA EUGENA (CSA)
Entity Type:Individual
Prefix:MRS
First Name:LA TOSHA
Middle Name:EUGENA
Last Name:WALKER
Suffix:
Gender:F
Credentials:CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BLOOMBRIDGE WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3486
Mailing Address - Country:US
Mailing Address - Phone:404-242-8548
Mailing Address - Fax:
Practice Address - Street 1:409 BLOOMBRIDGE WAY NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3486
Practice Address - Country:US
Practice Address - Phone:404-242-8548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-09
Last Update Date:2012-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical