Individual
DR. BERT PUCKETT WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
526 COLLEGE DR, BARNESVILLE, GA 30204-1713
(770) 358-3284
(770) 358-1015
Mailing address
526 COLLEGE DR, BARNESVILLE, GA 30204-1713
(770) 358-3284
(770) 358-1015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
048003
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00841035G
—
GA
01
—
52782413003
BC / BS
GA
Enumeration date
09/03/2006
Last updated
07/09/2007
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