Provider Demographics
NPI:1871544791
Name:WALL, ANTOINETTE WILKES (MD)
Entity type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:WILKES
Last Name:WALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:#7 GLENN BRIDGE RD
Mailing Address - Street 2:STE D
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-3333
Mailing Address - Country:US
Mailing Address - Phone:828-684-3949
Mailing Address - Fax:828-684-2330
Practice Address - Street 1:#7 GLENN BRIDGE RD
Practice Address - Street 2:STE D
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-3333
Practice Address - Country:US
Practice Address - Phone:828-684-3949
Practice Address - Fax:828-684-2330
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2012-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC20857207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8985383Medicaid
NC85383OtherBC
NC85383OtherBC
NC202548AMedicare ID - Type Unspecified