Individual
WILLIAM C WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
314 SOUTHWIND DR, RICHLAND, MS 39218-9215
(601) 502-4381
Mailing address
314 SOUTHWIND DR, RICHLAND, MS 39218-9215
(601) 502-4381
Taxonomy
Speciality
Code
Description
License number
State
246ZS0400X
—
Primary
154
GA
Other
Enumeration date
02/23/2026
Last updated
02/23/2026
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