Individual
ANSLEY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1199 PRINCE AVE, ATHENS, GA 30606-2797
(706) 475-7000
Mailing address
112 ROSE CREEK RD, EATONTON, GA 31024-7239
(706) 473-5303
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/05/2024
Last updated
08/05/2024
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