Individual
DR. JEFFREY GLEN WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1918 RANDOLPH RD STE 580, CHARLOTTE, NC 28207-1116
(704) 384-9900
(704) 384-9919
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-9900
(704) 384-9919
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
200300423
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
200300423
NC
207RP1001X
Pulmonary Disease Physician
200300423
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89134K9
—
NC
05
—
N0042B
—
SC
Enumeration date
03/25/2006
Last updated
02/20/2023
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