MEDICARE: DR. SCOT A WALL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	14675	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760487276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOT A WALL M.D.

Provider Business Mailing Address
First Line	:	2304 ROSEMONT CT
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-9110
Country	:	US
Telephone Number	:	229-888-5023
Fax Number	:

Provider Business Practice Location Address
First Line	:	2304 ROSEMONT CT
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-9110
Country	:	US
Telephone Number	:	229-888-5023
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	04/12/2017

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Directions to “ DR. SCOT A WALL M.D.” Practice Location

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