Provider Demographics
NPI:1518190388
Name:WALTERS, JUDY (RN)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 HICKORY ST STE 404
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2312
Mailing Address - Country:US
Mailing Address - Phone:706-270-5002
Mailing Address - Fax:706-270-5129
Practice Address - Street 1:705 N DIVISION ST NW
Practice Address - Street 2:BUILDING 315
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-1454
Practice Address - Country:US
Practice Address - Phone:706-802-5870
Practice Address - Fax:706-805-0654
Is Sole Proprietor?:No
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN094084163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent