Provider Demographics
NPI:1316837750
Name:WALLS, SAMUEL THOMAS
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:THOMAS
Last Name:WALLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 MILDRED AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-2823
Mailing Address - Country:US
Mailing Address - Phone:256-293-6815
Mailing Address - Fax:
Practice Address - Street 1:5527 MILDRED AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-2823
Practice Address - Country:US
Practice Address - Phone:256-293-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program