Provider Demographics
NPI:1639815103
Name:WALKER, DAVIONNE GENAI (MS, ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:DAVIONNE
Middle Name:GENAI
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 COTTON TAIL LN
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7270
Mailing Address - Country:US
Mailing Address - Phone:281-814-0341
Mailing Address - Fax:
Practice Address - Street 1:5425 ALOHA WAY
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542-2818
Practice Address - Country:US
Practice Address - Phone:470-248-2296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT004092207RS0010X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine