Provider Demographics
NPI:1396770921
Name:WALTHALL, JULIUS BYRON JR (MD)
Entity type:Individual
Prefix:DR
First Name:JULIUS
Middle Name:BYRON
Last Name:WALTHALL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10000 PARK CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-8902
Mailing Address - Country:US
Mailing Address - Phone:704-542-6577
Mailing Address - Fax:704-542-4405
Practice Address - Street 1:10000 PARK CEDAR DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8902
Practice Address - Country:US
Practice Address - Phone:704-542-6577
Practice Address - Fax:704-542-4405
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC26611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC85548OtherNCBCBS
NC8985548Medicaid
NC85548OtherNCBCBS
NCA78702Medicare UPIN