Michael Wall, PC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

MICHAEL WALL, PC

Practice address

362 High St
Maryville, TN 37804-5835

Phone

(865) 413-1589

Fax

(865) 205-9475

NPI assigned

Nov 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Wall, PANPI 1386794717

Title

Owner

Phone

(865) 995-4643

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Dwayne Wall, PA, ATC, PTA, CEAS

  • Physician Assistant
  • Powell, TN
  • NPI 1386794717
  Medicare reassignment Authorized official
• Jennifer B Terry, MPH, MS, RD, CCC-SLP

  • Speech-Language Pathologist
  • Maryville, TN
  • NPI 1144480542
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1669075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1023727633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5777",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378025777",
            "telephone_number": "865-246-2104",
            "fax_number": "865-246-2106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "362 HIGH ST",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378045835",
            "telephone_number": "865-413-1589",
            "fax_number": "865-205-9475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL WALL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-22",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "865-995-4643",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Morgan Elaine Merrick
• Melissa Carol Metcalf, RN
• Richard C Metelka, MD
• Rosemarie Jennifer Mexted, OTR
• Mfa Maryville Opco LLC
• Abigale Sarah Miller
• Craig Miller Jr., MD
• Paul Warrick Miller, M.D.
• Tanya Lynette Miller
• Emilee Blosser Milne, PT, DPT

• Primary Care Clinic/Center in Maryville, TN
• Providers in Maryville, TN by specialty
• Primary Care Clinic/Center in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.