Individual
MRS. ANNA EVERETT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5356 REYNOLDS ST STE 201, SAVANNAH, GA 31405-6019
(912) 232-9700
Mailing address
5501 ABERCORN ST STE D, SAVANNAH, GA 31405-6915
(912) 232-9700
(912) 748-0270
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
006278
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003114943C
—
GA
Enumeration date
09/12/2011
Last updated
10/05/2020
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