MEDICARE: DR. C. ARTHUR NALLS III MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	25915	VA
2	2084P0800X	Psychiatry Physician	0101025915	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043229198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. C. ARTHUR NALLS III MD

Provider Business Mailing Address
First Line	:	6353 CENTER DRIVE
Second Line	:	STE 204
City	:	NORFOLK
State	:	VA
Zip	:	23502-4112
Country	:	US
Telephone Number	:	757-461-3313
Fax Number	:	757-461-8363

Provider Business Practice Location Address
First Line	:	6353 CENTER DRIVE
Second Line	:	STE 204
City	:	NORFOLK
State	:	VA
Zip	:	23502-4112
Country	:	US
Telephone Number	:	757-461-3313
Fax Number	:	757-461-8363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	04/06/2016

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