Provider Demographics
NPI:1447520077
Name:THE WALK IN CLINIC LLC
Entity type:Organization
Organization Name:THE WALK IN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:K
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:770-929-9150
Mailing Address - Street 1:2890 HIGHWAY 212 SW
Mailing Address - Street 2:SUITE E
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3363
Mailing Address - Country:US
Mailing Address - Phone:770-929-9150
Mailing Address - Fax:770-929-9148
Practice Address - Street 1:2890 HIGHWAY 212 SW
Practice Address - Street 2:SUITE E
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3363
Practice Address - Country:US
Practice Address - Phone:770-929-9150
Practice Address - Fax:770-929-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care