Individual
STEPHANIE R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1230 BAXTER ST, ATHENS, GA 30606-3712
(706) 389-2273
(706) 389-2298
Mailing address
PO BOX 48089, ATHENS, GA 30604-8089
(706) 389-3740
(706) 389-3951
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN136273
GA
363LF0000X
Family Nurse Practitioner
RN136273
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
RN136273
GA
363LW0102X
Women's Health Nurse Practitioner
RN136279
GA
Other
Enumeration date
03/21/2006
Last updated
03/05/2026
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