Basic Information
| Provider Information | |||||||||
| NPI: | 1649265927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALLING | ||||||||
| FirstName: | GEORGE | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W STONE DR | ||||||||
| Address2: | SUITE 6A | ||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234087220 | ||||||||
| FaxNumber: | 4234087405 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 W RAVINE RD | ||||||||
| Address2: | |||||||||
| City: | KINGSPORT | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376603837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232244000 | ||||||||
| FaxNumber: | 4232243465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 05/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 11022 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 441965 | 01 | ANTHEM BCBS | OTHER | 3628991 | 05 | TN | MEDICAID | 3810000367 | 01 | WV MEDICAID | OTHER | 74004003 | 05 | KY | MEDICAID | TN0100 | 01 | JOHN DEERE | OTHER | 8902470 | 01 | VA | VA MEDICAID | OTHER | 100036230 | 01 | PHP TENNCARE | OTHER | 430064727 | 01 | RAILROAD MEDICARE | OTHER | 00013859 | 01 | NHC CARE ADMINISTRATORS | OTHER | 4018979 | 01 | BLUE SHIELD OF TN | OTHER |