Provider Demographics
NPI:1346462090
Name:WALKER LAKEBREEZE
Entity Type:Organization
Organization Name:WALKER LAKEBREEZE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PEARL
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-784-0187
Mailing Address - Street 1:440 LANG RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-6151
Mailing Address - Country:US
Mailing Address - Phone:770-784-0187
Mailing Address - Fax:770-788-3140
Practice Address - Street 1:440 LANG RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-6151
Practice Address - Country:US
Practice Address - Phone:770-784-0187
Practice Address - Fax:770-788-3140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health