BC Wall Medical Group PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9701190 Issued in NC

Legal business name

BC WALL MEDICAL GROUP PA

Practice address

1574 Union Road
A
Gastonia, NC 28054-5633

Phone

(704) 866-4607

Fax

(704) 866-5292

NPI assigned

Oct 10, 2007

Last updated

Oct 10, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Brian K Wall, M. D.

Title

President

Phone

(704) 866-4607

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1164610580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 CAMERON POINTE LN",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280126702",
            "telephone_number": "704-825-2363",
            "fax_number": "704-825-2363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1574 UNION ROAD",
            "address_2": "A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280545633",
            "telephone_number": "704-866-4607",
            "fax_number": "704-866-5292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BC WALL MEDICAL GROUP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "WALL",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "704-866-4607",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M. D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9701190",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891057P",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Gastonia, NC
• Providers in Gastonia, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.