Provider Demographics
NPI:1518569516
Name:WALLS LOGISTICS
Entity Type:Organization
Organization Name:WALLS LOGISTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELNISHA
Authorized Official - Middle Name:TAWANA
Authorized Official - Last Name:WALLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-750-1554
Mailing Address - Street 1:4905 BENTHAVEN LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-8972
Mailing Address - Country:US
Mailing Address - Phone:704-750-1554
Mailing Address - Fax:704-919-5998
Practice Address - Street 1:4905 BENTHAVEN LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-8972
Practice Address - Country:US
Practice Address - Phone:704-750-1554
Practice Address - Fax:704-919-5998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)