Provider Demographics
NPI:1154320422
Name:MARTZ, WALLIS H (NP)
Entity Type:Individual
Prefix:MRS
First Name:WALLIS
Middle Name:H
Last Name:MARTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2339 MCCALLIE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3256
Mailing Address - Country:US
Mailing Address - Phone:423-698-0850
Mailing Address - Fax:423-698-0511
Practice Address - Street 1:2339 MCCALLIE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3256
Practice Address - Country:US
Practice Address - Phone:423-698-0850
Practice Address - Fax:423-698-0511
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN50413363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00435620OtherRAILROAD MEDICARE
TN4156507OtherTENNESSEE BCBS
TN33491821Medicaid
TNP00435620OtherRAILROAD MEDICARE
TN33491821Medicaid