Individual
DR. JAMES DAVID WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3004 2ND ST SE, MOULTRIE, GA 31768-6797
(229) 891-9131
Mailing address
PO BOX 2876, MOULTRIE, GA 31776-2876
(229) 890-5305
(229) 890-5307
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
037415
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000565177H
—
GA
05
—
000565177I
—
GA
05
—
000565177J
—
GA
05
—
000565177K
—
GA
05
—
000565177L
—
GA
Enumeration date
06/14/2005
Last updated
07/28/2023
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