Individual
DAMON KEITH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 MANNING DR, CHAPEL HILL, NC 27514-4220
(919) 966-5136
Mailing address
101 MANNING DR, CHAPEL HILL, NC 27514-4220
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
261375
NC
Other
Enumeration date
04/24/2020
Last updated
04/24/2020
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