Individual
JUSTIN C. WALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-9687
(601) 703-9920
Mailing address
1314 19TH AVE, MERIDIAN, MS 39301-4116
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R860609
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02676766
—
MS
Enumeration date
10/18/2006
Last updated
02/27/2017
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