Individual
MRS. KELLY WHITE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
414 LUGENIA DR, VIDALIA, GA 30474-7210
(912) 537-9355
(912) 335-4804
Mailing address
PO BOX 1416, VIDALIA, GA 30475-1416
(706) 833-6848
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN170495
GA
Other
Enumeration date
10/03/2018
Last updated
10/03/2018
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