Provider Demographics
NPI:1649265927
Name:WALLING, GEORGE S (CRNA)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:S
Last Name:WALLING
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:130 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3837
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:423-224-3465
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11022367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
441965OtherANTHEM BCBS
TN3628991Medicaid
3810000367OtherWV MEDICAID
KY74004003Medicaid
TN0100OtherJOHN DEERE
VA8902470OtherVA MEDICAID
100036230OtherPHP TENNCARE
430064727OtherRAILROAD MEDICARE
00013859OtherNHC CARE ADMINISTRATORS
4018979OtherBLUE SHIELD OF TN
VA8902470OtherVA MEDICAID
430064727OtherRAILROAD MEDICARE