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General NPI Number Information
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NPI Number | 1922007525
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Entity Type | Organization
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Legal Business Name | SCOT A. WALL, MD, PC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 03/03/2008
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Provider Practice Location Address
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Address Line | 2308 PALMYRA RD
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City | ALBANY
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State | GA
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Zip | 31701-1324
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Country | US
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Telephone | 229-888-2395
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Fax |
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Provider Business Mailing Address
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Address Line | 2308 PALMYRA RD
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City | ALBANY
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State | GA
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Zip | 31701-1324
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Country | US
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Telephone | 229-888-2395
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. SCOT ALLEN WALL
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Credential | MD
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Telephone | 229-888-2395
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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