Raven Ifoma Elosiebo-Walker, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

74090 Issued in GA

Practice address

1462 Montreal Rd Ste 411
Tucker, GA 30084-6932

Phone

(404) 296-8000

Fax

(770) 493-6842

NPI assigned

May 4, 2011

Last updated

Mar 4, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

University of Tennessee, HSC, College of Medicine, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dermatology Specialists of Georgia LLCGroup PAC ID 5799770624, 16 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Dermatology Specialists of Georgia, LLC

  • Dermatology Physician
  • Athens, GA
  • NPI 1437298957
  Medicare reassignment Care Compare group NPD
• Southeastern Dermatology Group PA

  dba Dermatology Specialists

  • Dermatology Physician
  • Panama City, FL
  • NPI 1518972231

  GA

  Medicare reassignment NPD
• West Georgia Dermatology PC

  • Specialist
  • Lagrange, GA
  • NPI 1760493167
  NPD

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

{
    "created_epoch": "1304467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772582400000",
    "number": "1437441797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2505 HARRISON AVE",
            "city": "PANAMA CITY",
            "state": "FL",
            "postal_code": "324054464",
            "telephone_number": "850-233-3376",
            "fax_number": "850-522-8354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1462 MONTREAL RD STE 411",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300846932",
            "telephone_number": "404-296-8000",
            "fax_number": "770-493-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELOSIEBO-WALKER",
        "first_name": "RAVEN",
        "middle_name": "IFOMA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-04",
        "last_updated": "2026-03-04",
        "certification_date": "2026-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "74090",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roselyn Angel Ekperi, CPNP-PC
• Elite Medical Physicians PC
• Bruenetter Ellis Wright, ADDICTION COUNSELOR
• Angela Leslie Ellis, LPC
• Louisa Carns Ellis, LCSW
• Rebekah M Elting, RN
• Emory Physical Therapy, LLC
• Edwynta Engles
• Yasmine Tiara Enmon, NP-C
• ENT and Voice Care of Atlanta, Inc

• Dermatology Physician in Tucker, GA
• Providers in Tucker, GA by specialty
• Dermatology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.