Organization
BURLINGTON RADIOLOGICAL ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACK G WALL MD (PRESIDENT)
(336) 538-7000
Entity
Organization
Contact information
Practice address
1240 HUFFMAN MILL RD, BURLINGTON, NC 27215-8700
(336) 538-7861
(336) 538-7547
Mailing address
PO BOX 11546, KNOXVILLE, TN 37939-1546
(865) 766-8800
(865) 766-8874
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01145
BCBS OF NC
NC
05
—
8901145
—
NC
Enumeration date
04/07/2006
Last updated
07/21/2022
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