Individual
LEAH M WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1 MEADOWS PKWY, VIDALIA, GA 30474-8759
(912) 535-5800
(912) 535-5830
Mailing address
PO BOX 407, VIDALIA, GA 30475-0407
(912) 537-4986
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
007734
GA
Other
Enumeration date
10/19/2015
Last updated
10/17/2019
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