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General NPI Number Information
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NPI Number | 1457463861
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Entity Type | Individual
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Provider Name | CARRIE E WALLER M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 11/26/2024
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Provider Practice Location Address
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Address Line | 2609 W ARLINGTON BLVD STE 106
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City | GREENVILLE
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State | NC
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Zip | 27834-4168
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Country | US
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Telephone | 252-689-6303
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Fax | 252-689-6304
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Provider Business Mailing Address
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Address Line | 2609 W ARLINGTON BLVD STE 106
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City | GREENVILLE
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State | NC
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Zip | 27834-4168
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Country | US
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Telephone | 252-689-6303
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Fax | 252-689-6304
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 200401596
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 200401596
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License Number State | NC
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