Provider Demographics
NPI:1760262190
Name:WALKA FAMILY PRACTICE LLC
Entity Type:Organization
Organization Name:WALKA FAMILY PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:706-670-9818
Mailing Address - Street 1:102 W LAFAYETTE SQ STE 207
Mailing Address - Street 2:
Mailing Address - City:LA FAYETTE
Mailing Address - State:GA
Mailing Address - Zip Code:30728-3520
Mailing Address - Country:US
Mailing Address - Phone:706-670-9818
Mailing Address - Fax:706-236-7700
Practice Address - Street 1:102 W LAFAYETTE SQ STE 207
Practice Address - Street 2:
Practice Address - City:LA FAYETTE
Practice Address - State:GA
Practice Address - Zip Code:30728-3520
Practice Address - Country:US
Practice Address - Phone:706-670-9818
Practice Address - Fax:706-236-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty