Basic Information
| Provider Information | |||||||||
| NPI: | 1487642278 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | ANGELA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | NORTHSIDE HOSPITAL - MANAGED CARE DEPARTMENT | ||||||||
| Address2: | 1000 JOHNSON FERRY RD NE | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30342 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043002476 | ||||||||
| FaxNumber: | 4042508010 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR STE 350 | ||||||||
| Address2: | |||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2005 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | L2733 | TX | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 073667 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 149091402 | 05 | TX | MEDICAID | 207V00000X | 01 | GA | TAXONOMY | OTHER | 073667 | 01 | GA | STATE LICENSE | OTHER | 1487642278 | 01 | GA | NPI | OTHER |