Provider Demographics
NPI:1730502204
Name:WALTOWER, PATRICIA A (RN MSHS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:WALTOWER
Suffix:
Gender:F
Credentials:RN MSHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6045 BUCHANAN CIR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30252-7670
Mailing Address - Country:US
Mailing Address - Phone:678-485-7161
Mailing Address - Fax:678-782-5988
Practice Address - Street 1:6045 BUCHANAN CIR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30252-7670
Practice Address - Country:US
Practice Address - Phone:678-485-7161
Practice Address - Fax:678-782-5988
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator