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Individual

DR. GERALD CARTER WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1120 15TH ST, AUGUSTA, GA 30912-0004
(706) 721-1990
Mailing address
1120 15TH ST, AUGUSTA, GA 30912-0004

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
009670
GA
2084N0400X
Neurology Physician
Primary
92768
GA

Other

Enumeration date
06/29/2017
Last updated
10/09/2023
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