Provider Demographics
NPI: | 1790721546 |
---|---|
Name: | WALLS, CHRISTOPHER E (MD) |
Entity Type: | Individual |
Prefix: | |
First Name: | CHRISTOPHER |
Middle Name: | E |
Last Name: | WALLS |
Suffix: | |
Gender: | M |
Credentials: | MD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | PO BOX 116336 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 30368-6336 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 866-957-8346 |
Mailing Address - Fax: | 912-355-1414 |
Practice Address - Street 1: | 4750 WATERS AVE |
Practice Address - Street 2: | SUITE 500 |
Practice Address - City: | SAVANNAH |
Practice Address - State: | GA |
Practice Address - Zip Code: | 31404 |
Practice Address - Country: | US |
Practice Address - Phone: | 866-957-8346 |
Practice Address - Fax: | 912-355-1414 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-21 |
Last Update Date: | 2022-09-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
GA | 031854 | 2086S0129X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | G31854 | Medicaid | |
GA | 000508494I | Medicaid | |
GA | 000508494H | Medicaid | |
SC | G31854 | Medicaid | |
GA | P00165884 | Medicare PIN | |
GA | 02BDHSX | Medicare PIN | |
GA | 000508494H | Medicaid | |
GA | P00666561 | Medicare PIN |