Individual
LISA M WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1100 LAKE HEARN DRIVE, STE #450, ATLANTA, GA 30342
(404) 252-7339
(404) 257-0337
Mailing address
1100 LAKE HEARN DRIVE, STE 450, ATLANTA, GA 30342
(404) 252-7339
(404) 257-0337
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
004516
NH
Other
Enumeration date
07/10/2006
Last updated
07/08/2007
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