Provider Demographics
NPI:1871516815
Name:WALKER, MIA YVETTE (DC)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:YVETTE
Last Name:WALKER
Suffix:
Gender:F
Credentials:DC
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 50112
Mailing Address - Street 2:400 PRYOR STREET
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302
Mailing Address - Country:US
Mailing Address - Phone:470-222-5101
Mailing Address - Fax:
Practice Address - Street 1:241 PEACHTREE ST NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-1424
Practice Address - Country:US
Practice Address - Phone:470-222-5101
Practice Address - Fax:678-609-5438
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR007147111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADD2924OtherRAILROAD
GAP00031819OtherRAILROAD MEDICARE
GA00961804AMedicaid
GADD2924OtherRAILROAD
GA00961804AMedicaid