Provider Demographics
NPI:1568217917
Name:WALKER, INDIA CRISTIANA
Entity Type:Individual
Prefix:
First Name:INDIA
Middle Name:CRISTIANA
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHELTON DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-3124
Mailing Address - Country:US
Mailing Address - Phone:404-509-1597
Mailing Address - Fax:
Practice Address - Street 1:5530 OLD DIXIE HWY
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-2698
Practice Address - Country:US
Practice Address - Phone:404-509-1597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician