Individual
JULIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RD,LD,CSP
Contact information
Practice address
1229 JOHNSON FERRY RD STE 204B, MARIETTA, GA 30068-5416
(404) 692-6902
Mailing address
3337 PREAKNESS CT, MARIETTA, GA 30062-5553
(404) 862-9337
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
86006561
GA
Other
Enumeration date
08/11/2017
Last updated
07/27/2023
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