Individual
JACLYN RENEE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NNP-BC
Contact information
Practice address
1711 TULLIE CIR NE, ATLANTA, GA 30329-2305
(404) 785-5413
(404) 785-6233
Mailing address
1711 TULLIE CIR NE, ATLANTA, GA 30329-2305
(404) 785-5413
(404) 785-6233
Taxonomy
Speciality
Code
Description
License number
State
363LN0005X
Critical Care Neonatal Nurse Practitioner
Primary
RN211895
GA
Other
Enumeration date
04/12/2017
Last updated
04/12/2017
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