Individual
KELLY E. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP-BC
Contact information
Practice address
1199 PRINCE AVE, #7, ATHENS, GA 30606-2797
(706) 475-1700
Mailing address
1199 PRINCE AVE, #7, ATHENS, GA 30606-2797
(706) 475-1700
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN198482
GA
Other
Enumeration date
09/12/2013
Last updated
09/12/2013
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