Provider Demographics
NPI:1841863446
Name:WALLER, VALERIE D
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:D
Last Name:WALLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 82461
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30608-2461
Mailing Address - Country:US
Mailing Address - Phone:678-993-4132
Mailing Address - Fax:706-395-6226
Practice Address - Street 1:157 CABIN CREEK RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2463
Practice Address - Country:US
Practice Address - Phone:706-395-6152
Practice Address - Fax:706-395-6226
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health