Provider Demographics
NPI:1285628891
Name:WALTERS, JACQUELINE MACHE (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:MACHE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:5780 PEACHTREE DUNWOODY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1513
Mailing Address - Country:US
Mailing Address - Phone:404-303-1224
Mailing Address - Fax:404-303-1325
Practice Address - Street 1:3630 SAVANNAH PL STE 100
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-5028
Practice Address - Country:US
Practice Address - Phone:678-474-0203
Practice Address - Fax:678-474-0207
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040275207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000750241DMedicaid
GAGRP3569OtherOPTOUT