Individual
JAMES JEFFERSON WALLACE III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4143 COLUMBIA RD, SUITE D, MARTINEZ, GA 30907
(706) 651-1299
(706) 651-1145
Mailing address
4143 COLUMBIA RD, SUITE D, MARTINEZ, GA 30907
(706) 651-1299
(706) 651-1145
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
024369
GA
Other
Enumeration date
05/01/2007
Last updated
06/12/2024
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