Provider Demographics
NPI:1558641308
Name:WALTERS, LEONA MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 BATTLECREEK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2407
Mailing Address - Country:US
Mailing Address - Phone:678-610-7198
Mailing Address - Fax:770-603-4872
Practice Address - Street 1:1117 BATTLECREEK RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2407
Practice Address - Country:US
Practice Address - Phone:678-610-7198
Practice Address - Fax:770-603-4872
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA098468NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner