Individual
ALEXIS NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
AUGUSTA UNIVERSITY MEDICAL CENTER, 1120 15TH ST, GA 30912
(706) 721-2273
Mailing address
INTERNAL MEDICINE RESIDENCY 1120 15TH ST, AUGUSTA, GA 30912-0001
(706) 721-2273
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12864
GA
207R00000X
Internal Medicine Physician
LL84507
SC
Other
Enumeration date
06/19/2020
Last updated
12/15/2021
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