Healthcare Provider Details

I. General information

NPI: 1629120902
Provider Name (Legal Business Name): ALBERT MARTIN WALL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 E BROAD ST
SAVANNAH GA
31401-2917
US

IV. Provider business mailing address

128 W LIBERTY ST
SAVANNAH GA
31401-3908
US

V. Phone/Fax

Practice location:
  • Phone: 912-527-1000
  • Fax:
Mailing address:
  • Phone: 912-495-0032
  • Fax: 912-651-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number13099
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: