Provider Demographics
NPI:1871247650
Name:WALKER, KEISHA (RPT/ RMA)
Entity Type:Individual
Prefix:
First Name:KEISHA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:RPT/ RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 BROWNING BEND CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7775
Mailing Address - Country:US
Mailing Address - Phone:770-702-0340
Mailing Address - Fax:
Practice Address - Street 1:3300 HOLCOMB BRIDGE RD STE 250
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-3298
Practice Address - Country:US
Practice Address - Phone:770-702-0340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2472E0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherEEGGroup - Single Specialty