Individual
CHARLES T WALLS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
915 MEDICAL CIR, MYRTLE BEACH, SC 29572-4116
(843) 213-1790
(843) 213-1830
Mailing address
915 MEDICAL CIRCLE, MYRTLE BEACH, SC 29572-4116
(843) 213-1790
(843) 213-1830
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
11073
SC
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
11073
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110739
—
SC
05
—
890684H
—
NC
Enumeration date
01/24/2006
Last updated
03/17/2018
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