Provider Demographics
NPI:1922297654
Name:WALL, AMY BARTA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BARTA
Last Name:WALL
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1214 REYNOLDA RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1151
Mailing Address - Country:US
Mailing Address - Phone:336-723-2555
Mailing Address - Fax:336-723-9007
Practice Address - Street 1:1214 REYNOLDA RD
Practice Address - Street 2:SUITE A
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1151
Practice Address - Country:US
Practice Address - Phone:336-723-2555
Practice Address - Fax:336-723-9007
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2010-11-03
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Provider Licenses
StateLicense IDTaxonomies
NC9800734207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7910405Medicaid
4301550001Medicare NSC