Revell, Walter J
Revell, Walter J is an individual health care provider with primary practice located at 305 W 1St St , Vidalia GA 30474-3302. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Revell, Walter J can be contacted via phone (912) 538-9080.Contact Information
Primary practice address
305 W 1St St
Vidalia GA 30474-3302
Phone: (912) 538-9080
Fax: (912) 538-9085
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 11191 | South Carolina |
Profile Details
| NPI number | 1275641995 |
|---|---|
| LBN Legal business name | Revell, Walter J |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 25th, 2006 |
| Last updated | May 1st, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275641995 | NPPES |
| South Carolina | MEDICAID | 111916 |
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