Individual
DR. WALLACE EARL HOLLAND JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
10055 FORD AVE, SUITE 5A, RICHMOND HILL, GA 31324-3972
(912) 756-2020
(912) 756-3187
Mailing address
10055 FORD AVE, SUITE 5A, RICHMOND HILL, GA 31324-3972
(912) 756-2020
(912) 756-3187
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
024438
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
681687
BCBS
GA
05
—
G24438
—
SC
Enumeration date
07/14/2005
Last updated
10/05/2007
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