Individual
BRIAN KEITH WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2301 S LAMAR BLVD, OXFORD, MS 38655-5373
(662) 232-8568
(662) 513-1450
Mailing address
P.O. BOX 405827, ATLANTA, GA 30384-5827
(870) 934-5821
(870) 934-5384
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
9701190
NC
208M00000X
Hospitalist Physician
Primary
20143
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00680358
—
MS
05
—
891057P
—
NC
Enumeration date
07/24/2006
Last updated
11/10/2010
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