Individual
WALTER J REVELL JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
305 W 1ST ST, VIDALIA, GA 30474-3302
(912) 538-9080
(912) 538-9085
Mailing address
305 W 1ST ST, VIDALIA, GA 30474-3302
(912) 538-9080
(912) 538-9085
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
11191
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
111916
—
SC
Enumeration date
08/25/2006
Last updated
05/01/2018
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