| Michael Wall, PC | |
|
362 High St Maryville TN 37804-5835 | |
| (865) 413-1589 | |
| (865) 205-9475 |
| Full Name | Michael Wall, PC |
|---|---|
| Speciality | Clinic/Center |
| Location | 362 High St, Maryville, Tennessee |
| Authorized Official Name and Position | Michael Wall (OWNER) |
| Authorized Official Contact | 8659954643 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Wall, PC Po Box 5777 Maryville TN 37802-5777 Ph: (865) 246-2104 | Michael Wall, PC 362 High St Maryville TN 37804-5835 Ph: (865) 413-1589 |
| NPI Number | 1023727633 |
|---|---|
| Provider Enumeration Date | 11/22/2022 |
| Last Update Date | 11/22/2022 |
| Certification Date | 11/22/2022 |
| Medicare PECOS PAC ID | 3870963952 |
|---|---|
| Medicare Enrollment ID | O20230106000141 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023727633 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Michael Dwayne Wall |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1386794717 PECOS PAC ID: 2466632955 Enrollment ID: I20110216000396 |
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