Individual
JOHN BURTON WALLACE V
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1123 CLAIRMONT RD, DECATUR, GA 30030-1207
(917) 392-6700
Mailing address
1736 OAKVIEW RD, DECATUR, GA 30030-4235
(917) 392-6700
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
07/12/2013
Last updated
03/18/2024
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