Provider Demographics
NPI:1861134645
Name:WALKER-MULLIX, KISHMA A
Entity type:Individual
Prefix:MRS
First Name:KISHMA
Middle Name:A
Last Name:WALKER-MULLIX
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 1:25 FOURWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-7838
Mailing Address - Country:US
Mailing Address - Phone:678-923-6967
Mailing Address - Fax:
Practice Address - Street 1:25 FOURWOOD CT
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-7838
Practice Address - Country:US
Practice Address - Phone:678-923-6967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver