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General NPI Number Information
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NPI Number | 1376432401
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Entity Type | Individual
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Provider Name | DEJA WALLS PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 07/02/2025
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Provider Practice Location Address
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Address Line | 2569 DOUGLASS AVE
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City | MEMPHIS
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State | TN
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Zip | 38114-2532
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Country | US
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Telephone | 901-842-3164
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Fax |
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Provider Business Mailing Address
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Address Line | 8860 PRESTANCIA CV S
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City | MEMPHIS
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State | TN
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Zip | 38125-1734
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Country | US
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Telephone | 901-461-7045
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1231052
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License Number State |
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