Individual
RANDY WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
651 DUNLOP LN, CLARKSVILLE, TN 37040-5015
(931) 502-1370
(615) 269-0135
Mailing address
2020 21ST AVE S, SUITE 201, NASHVILLE, TN 37212-4354
(615) 269-0652
(615) 269-0135
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
446
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00367293
RAILROAD MEDICARE
TN
Enumeration date
09/16/2006
Last updated
08/04/2011
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