Individual
JACK G WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1240 HUFFMAN MILL RD, BURLINGTON, NC 27215-8700
(336) 538-7000
(336) 538-7547
Mailing address
PO BOX 11546, KNOXVILLE, TN 37939-1546
(336) 538-7000
(336) 538-7547
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
16037
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
85385
BCBS
NC
05
—
8985385
—
NC
Enumeration date
04/10/2006
Last updated
11/09/2007
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