Individual
DR. COLBY EVAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.T.
Contact information
Practice address
12 EXECUTIVE PARK DR NE, ATLANTA, GA 30329-2206
(404) 778-3444
Mailing address
7208 NORTHLAKE HEIGHTS CIR NE, ATLANTA, GA 30345-2262
(615) 653-9596
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
PT012499
GA
Other
Enumeration date
08/17/2016
Last updated
08/17/2016
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