Individual
MRS. VICKI JO WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
829 RIVERBEND DR, GADSDEN, AL 35901-2556
(256) 546-4611
(256) 546-2214
Mailing address
829 RIVERBEND DR, GADSDEN, AL 35901-2556
(256) 546-4611
(256) 546-2214
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
22626
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114331
—
AL
Enumeration date
05/10/2006
Last updated
06/05/2013
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