Provider Demographics
NPI:1588716302
Name:PASCHALL, WALTER J (MD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:J
Last Name:PASCHALL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 MORNINGSTAR WAY
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-6214
Mailing Address - Country:US
Mailing Address - Phone:770-361-5556
Mailing Address - Fax:770-393-1557
Practice Address - Street 1:1611 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4224
Practice Address - Country:US
Practice Address - Phone:770-361-5556
Practice Address - Fax:770-393-1557
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044055207W00000X
TXD2550207W00000X
WV13376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV13376OtherPERMANENT LICENSE
GA044055OtherMEDICAL LICENSE
TXD2550OtherTEXAS MEDICAL LICENSE NUMBER
9332288Medicare PIN
WV13376OtherPERMANENT LICENSE