Individual
DR. J. GREGORY WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM,P.C.
Contact information
Practice address
602 PAT HARALSON DR, BLAIRSVILLE, GA 30512-8414
(706) 745-6764
(706) 745-7170
Mailing address
602 PAT HARALSON DR, BLAIRSVILLE, GA 30512-8414
(706) 745-6764
(706) 745-7170
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
000746
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000642672A
—
GA
Enumeration date
07/19/2006
Last updated
06/05/2012
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