Waller, Charles

Waller, Charles is an individual health care provider with primary practice located at 218 Bass Ln , Benton KY 42025-5824. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Allopathic & Osteopathic Physicians / Emergency Medicine. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Waller, Charles can be contacted via phone (270) 556-3239.

Contact Information

Primary practice address
218 Bass Ln Benton KY 42025-5824
Phone: (270) 556-3239
Fax: (270) 354-5865
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 29738 Kentucky
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 29738 Kentucky

Profile Details

NPI number 1306841341
LBN Legal business name Waller, Charles
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 16th, 2005
Last updated Feb 1st, 2017 - about 8 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306841341 NPPES
Tennessee MEDICAID 4047217
Tennessee MEDICAID 64297385

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