Individual
JOHN MATHEW WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-5000
Mailing address
770 EDGEWATER LN NW, KENNESAW, GA 30144-5118
(201) 919-4717
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
7073
NC
Other
Enumeration date
01/06/2023
Last updated
01/06/2023
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