Individual provider Active NPI

Susan Wheeler Walter, APRN,BC

  • Nurse Practitioner
  • Griffin, GA
National Provider Identifier
1184826638
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN078025 Issued in GA
Practice address
231 Graefe St
Griffin, GA 30224-4222
Phone
(770) 227-1587
Fax
(770) 227-1485
NPI assigned
Jun 5, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN078025 GA Primary

Addresses

Primary practice location

231 Graefe St
Griffin, GA 30224-4222

Mailing address

231 Graefe St
Griffin, GA 30224-4222
Phone (770) 227-1587

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140124000551 GA Practitioner - Nurse Practitioner 9537397377 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Internal Medicine of Griffin CurrentSince May 23, 2007 Accepting new patients
Qcpi-Villagemd, PC CurrentSince May 3, 2021 Accepting new patients
Laboratory Corporation of America Holdings Past Accepting new patients

Locations

619 S 8th St
Ste 200
Griffin, GA 30224
Phone (770) 227-1587

1805 Parke Plaza Cir
Ste 101
Stone Mtn, GA 30087
Phone (770) 469-7000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184826638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "231 GRAEFE ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244222",
            "telephone_number": "770-227-1587",
            "fax_number": "770-227-1485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "231 GRAEFE ST",
            "city": "GRIFFIN",
            "state": "GA",
            "postal_code": "302244222",
            "telephone_number": "770-227-1587",
            "fax_number": "770-227-1485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "SUSAN",
        "middle_name": "WHEELER",
        "credential": "APRN,BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN078025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Griffin, GA

Sources for this page

Verify at the official NPI Registry.