Healthcare Provider Details

I. General information

NPI: 1033162375
Provider Name (Legal Business Name): WALTER DAVIS ARNOLD JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PARK BLVD
BRISTOL TN
37620-7430
US

IV. Provider business mailing address

119 BOONE RIDGE DR SUITE 201
JOHNSON CITY TN
37615-4998
US

V. Phone/Fax

Practice location:
  • Phone: 423-282-1480
  • Fax: 423-928-1353
Mailing address:
  • Phone: 423-282-1480
  • Fax: 423-928-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036-096921
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number40585
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: