Provider Demographics
NPI:1639796196
Name:WALKER, EMMA LIEGH (FNP-C)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:LIEGH
Last Name:WALKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 W BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-4201
Mailing Address - Country:US
Mailing Address - Phone:229-436-2594
Mailing Address - Fax:
Practice Address - Street 1:1408 TALLAHASSEE HWY STE Z
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-7791
Practice Address - Country:US
Practice Address - Phone:229-400-9033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-01
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF10190607363LC1500X
GA1639796196363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC1500XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCommunity Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily