Individual
DR. ALAN S WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 MIMOSA DRIVE, THOMASVILLE, GA 31792
(229) 226-8881
(229) 225-2165
Mailing address
100 MIMOSA DRIVE, THOMASVILLE, GA 31792
(229) 226-8881
(229) 225-2165
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
018761
GA
208600000X
Surgery Physician
Primary
018761
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000394732A
PEACH STATE
GA
05
—
000394732A
—
GA
05
—
000394732G
—
GA
01
—
110153553
RAILROAD MEDICARE
GA
01
—
207450
WELLCARE
GA
Enumeration date
01/13/2006
Last updated
06/25/2015
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