Individual
JACQUELINE THOMAS WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
803 FLOYD AVE, DEMOPOLIS, AL 36732-3157
(334) 349-6916
Mailing address
803 FLOYD AVE, DEMOPOLIS, AL 36732-3157
(334) 349-6916
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1-080172
AL
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
01/30/2017
Last updated
01/30/2017
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