Individual
WALLACE EDWIN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
410 PEACHTREE PKWY STE 300, CUMMING, GA 30041-7407
(404) 255-1933
(404) 785-2822
Mailing address
410 PEACHTREE PKWY STE 300, CUMMING, GA 30041-7407
(404) 255-1933
(404) 785-2822
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4053
GA
Other
Enumeration date
01/12/2006
Last updated
06/06/2022
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