Individual
WILLIAM WALLACE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
777 HEMLOCK ST, MACON, GA 31201
(478) 633-1000
Mailing address
777 HEMLOCK STREET, MACON, GA 31201
(478) 633-1891
(478) 633-5153
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
86402
GA
Other
Enumeration date
03/24/2017
Last updated
01/30/2023
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