Individual
THERRION WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2412 ANTEBELLUM DR # A, AUGUSTA, GA 30906-3383
(706) 372-3886
Mailing address
2412 ANTEBELLUM DR # A, AUGUSTA, GA 30906-3383
(706) 372-3886
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
10/15/2025
Last updated
10/15/2025
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