Individual
JENNIFER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 EXETER RD, GERMANTOWN, TN 38138-3966
(901) 757-1350
(901) 757-3496
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5800
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1977
TN
Other
Enumeration date
04/05/2017
Last updated
04/05/2017
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