Individual
PAUL WALLACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 724-6100
Mailing address
1499 WALTON WAY, SUITE 1400, AUGUSTA, GA 30901-2603
(706) 724-6100
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME47110
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04202
BLUE CROSS BLUE SHIELD
FL
05
—
046650600
—
FL
Enumeration date
08/11/2006
Last updated
01/04/2021
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