Organization · NPI-2

Bc Wall Medical Group PA

Internal Medicine · Gastonia, NC

NPI number1164610580
StatusActive
Last updated in NPPESOct 10, 2007

Details

NPI
1164610580
Entity type
Organization (NPI-2)
Legal business name
Bc Wall Medical Group PA
Organization subpart
No
Enumeration date
Oct 10, 2007
Last updated
Oct 10, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine9701190NCYes

Practice location

1574 Union Road
A
Gastonia, NC 28054-5633

Phone 704-866-4607 · Fax 704-866-5292

Mailing address

557 Cameron Pointe Ln
Belmont, NC 28012-6702

Phone 704-825-2363 · Fax 704-825-2363

Authorized official

Brian K Wall
President
7048664607

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