Provider Demographics
NPI:1285004960
Name:WALLS ADVANCED PRACTICE HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:WALLS ADVANCED PRACTICE HEALTHCARE, P.C.
Other - Org Name:SCENIC CITY FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INCORPORATOR/NP
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, NP-C
Authorized Official - Phone:423-227-7676
Mailing Address - Street 1:5720 UPTAIN RD
Mailing Address - Street 2:SUITE 4600
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37411-5510
Mailing Address - Country:US
Mailing Address - Phone:423-227-7676
Mailing Address - Fax:
Practice Address - Street 1:5720 UPTAIN RD
Practice Address - Street 2:SUITE 4600
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37411-5510
Practice Address - Country:US
Practice Address - Phone:423-227-7676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000015977363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty