Individual
CHARLES EDWARD WALL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
102 DOCTORS PARK, STARKVILLE, MS 39759-2570
(662) 615-3800
(662) 615-3807
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(901) 226-4003
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
19801
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102I029294
MEDICARE
AL
05
—
175531
—
AL
01
—
511-65666
BCBS
AL
Enumeration date
06/13/2007
Last updated
10/06/2025
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