Provider Demographics
NPI:1598408320
Name:WALLS, CARLOS D
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:D
Last Name:WALLS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MELINDA
Other - Middle Name:M
Other - Last Name:GLENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1135 ARLINGTON AVE SW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44706-1448
Mailing Address - Country:US
Mailing Address - Phone:234-214-3370
Mailing Address - Fax:
Practice Address - Street 1:1135 ARLINGTON AVE SW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44706-1448
Practice Address - Country:US
Practice Address - Phone:234-214-3370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider