Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Walter J Revell Jr., MD

Individual provider Surgery Physician · NPI 1275641995

Walter J Revell Jr., MD is a General Surgery in Vidalia, Georgia. Graduated from Medical College of Georgia School of Medicine in 1974, 52 years ago. Practices with Peterson Dermatology, PC, a 4-clinician group and accepts Medicare assignment. Licensed in South Carolina.

Years since qualifying
52
Trained at
Medical College of Georgia School of Medicine
Licensed in
SC
In the registry since
2006
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

305 W 1st St
Vidalia, GA 30474-3302
Phone: (912) 538-9080
Fax: (912) 538-9085
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgery Physician (primary) Taxonomy 208600000X · Licence 11191 (SC)

Record details

NPI number1275641995
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedAugust 25, 2006
Last updated in NPPESMay 1, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyGENERAL SURGERY
Medical schoolMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated 1974 (52 years in practice)
Group practice Peterson Dermatology, P.C. — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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