Organization
J D WALLACE ENTERPRISES LLC
Active
Organization
J D WALLACE ENTERPRISES LLC
Active
Other names
Family Health Care Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN D WALLACE (CEO)
(252) 349-1025
Entity
Organization
Contact information
Practice address
4292 MEMORIAL DR STE B, DECATUR, GA 30032-1224
(678) 928-9427
Mailing address
4292 MEMORIAL DR STE B, DECATUR, GA 30032-1224
(678) 928-9427
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
06/28/2010
Last updated
06/28/2010
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