Individual
CARRIE P. WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
877 JEFFERSON AVE, MEMPHIS, TN 38103-2807
(901) 545-8090
(901) 545-9529
Mailing address
877 JEFFERSON AVE, ATTN: PROVIDER ENROLLMENT, MEMPHIS, TN 38103-2807
(901) 545-7302
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2833
TN
363A00000X
Physician Assistant
—
—
Other
Enumeration date
08/10/2015
Last updated
09/23/2015
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