Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 126800000X | Dental Assistant |
NPI | 1083062814 |
---|---|
Provider Name | Scharon M Walls |
First Address | Columbus, GA 31907-5363 |
Second Address | Fort Benning, GA 31905-5645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2016 |
Last Update Date | 18/11/2021 |