Provider Demographics
NPI:1629749957
Name:WALKER, AMANDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 N GWINNETT ST
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-2619
Mailing Address - Country:US
Mailing Address - Phone:770-823-4413
Mailing Address - Fax:
Practice Address - Street 1:45 N GWINNETT ST
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-2619
Practice Address - Country:US
Practice Address - Phone:770-823-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004528103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist