Organization
VALDOSTA FOOT & ANKLE CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R. WALLACE D.P.M. (OWNER)
(229) 244-1211
Entity
Organization
Contact information
Practice address
2800 N OAK ST, VALDOSTA, GA 31602-1716
(229) 244-1211
(229) 244-2721
Mailing address
2800 N OAK ST, VALDOSTA, GA 31602-1716
(229) 244-1211
(229) 244-2721
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
—
—
Other
Enumeration date
07/20/2007
Last updated
09/18/2013
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