1588716302 NPI number — DR. WALTER J PASCHALL MD

Table of content: DR. WALTER J PASCHALL MD (NPI 1588716302)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588716302 NPI number — DR. WALTER J PASCHALL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PASCHALL
Provider First Name:
WALTER
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588716302
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 MORNINGSTAR WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALL GROUND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30107-6214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-361-5556
Provider Business Mailing Address Fax Number:
770-393-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1611 MOUNT VERNON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNWOODY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30338-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-361-5556
Provider Business Practice Location Address Fax Number:
770-393-1557
Provider Enumeration Date:
01/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  044055 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207W00000X , with the licence number: D2550 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: 13376 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 13376 . This is a "PERMANENT LICENSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 044055 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: D2550 . This is a "TEXAS MEDICAL LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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