Individual
JESSICA BOWMAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
253 COUNTY ROAD 766, CEDAR BLUFF, AL 35959-3595
(256) 899-9147
Mailing address
304 TURNER MCCALL BLVD SW, ROME, GA 30165-5621
(706) 509-6110
(706) 509-6101
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
RN241671
GA
Other
Enumeration date
02/23/2021
Last updated
02/23/2021
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