Provider Demographics
NPI:1881430064
Name:WALL, NATARSHA MONYANMAH (NP)
Entity type:Individual
Prefix:MRS
First Name:NATARSHA
Middle Name:MONYANMAH
Last Name:WALL
Suffix:
Gender:
Credentials:NP
Other - Prefix:MRS
Other - First Name:NATASHA
Other - Middle Name:MONYANMAH
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:503 WALES DR
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-8404
Mailing Address - Country:US
Mailing Address - Phone:973-868-1897
Mailing Address - Fax:
Practice Address - Street 1:766 WALTHER RD STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8765
Practice Address - Country:US
Practice Address - Phone:770-736-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN260650363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care