Individual
FRANKLIN W WALLER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
502 BROAD ST, COLUMBIA, MS 39429-3037
(601) 736-8282
(601) 736-8333
Mailing address
415 S 28TH AVE, HATTIESBURG, MS 39401-7246
(601) 736-8282
(601) 579-5240
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
15125
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00117443
—
MS
01
—
080096788
RAILROAD MEDICARE
MS
05
—
1582301
—
LA
01
—
640507572AY
AMERICAN ADMIN GROUP
MS
Enumeration date
08/30/2006
Last updated
08/23/2016
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