=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285004960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALLS ADVANCED PRACTICE HEALTHCARE, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/07/2015
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1042 GRAYSVILLE RD STE 2
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-661-3600
-----------------------------------------------------
Fax | 423-661-3602
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1042 GRAYSVILLE RD STE 2
-----------------------------------------------------
City | CHATTANOOGA
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37421-4389
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-661-3600
-----------------------------------------------------
Fax | 423-661-3602
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INCORPORATOR/NP
-----------------------------------------------------
Name | DR. CHRISTOPHER BRIAN WALLS
-----------------------------------------------------
Credential | DNP, APN, NP-C
-----------------------------------------------------
Telephone | 423-488-3003
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APN0000015977
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------