Individual
BRIAN STEVEN WALLIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6600 VAN AALST BLVD, FORT BENNING, GA 31905
(762) 408-2273
Mailing address
6600 VAN AALST BLVD, FORT BENNING, GA 31905-2102
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0102203815
VA
207Q00000X
Family Medicine Physician
78492
GA
Other
Enumeration date
06/12/2012
Last updated
08/05/2022
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