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General NPI Number Information
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NPI Number | 1790019800
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Entity Type | Individual
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Provider Name | CHARLES EDWARD WALTON II PA
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Gender | Male
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 06/06/2025
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Provider Practice Location Address
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Address Line | 102 W MAIN ST
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City | WALLACE
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State | NC
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Zip | 28466-2902
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Country | US
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Telephone | 910-788-4242
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Fax | 910-809-4641
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Provider Business Mailing Address
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Address Line | PO BOX 936857
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City | ATLANTA
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State | GA
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Zip | 31193-6857
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Country | US
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Telephone |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-02027
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-02027
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License Number State | NC
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