Provider Demographics
NPI:1174073993
Name:WALLS, ADAM BRENT I
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:BRENT
Last Name:WALLS
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 TREETOP TRL APT C
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-8681
Mailing Address - Country:US
Mailing Address - Phone:330-904-1466
Mailing Address - Fax:
Practice Address - Street 1:1784 TREETOP TRL APT C
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-8681
Practice Address - Country:US
Practice Address - Phone:330-904-1466
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator