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Individual

MR. ANTHONY WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
N.P.

Contact information

Practice address
740 PRINCE AVE, ATHENS, GA 30606-5908
(706) 548-0008
(706) 369-9673
Mailing address
340 N MILLEDGE AVE STE B, ATHENS, GA 30601-3806
(706) 548-0008
(706) 369-9673

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R045285
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
988504591A
GA
Enumeration date
02/01/2007
Last updated
02/05/2018
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