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Individual

DR. WALLACE W WEATHERLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1801 CRANE RIDGE DR, SUITE C, JACKSON, MS 39216-4902
(601) 981-5633
(601) 981-1844
Mailing address
907 E SUNFLOWER RD, STE 102, CLEVELAND, MS 38732-2830
(662) 843-8885
(662) 843-2280

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
11796
MS

Other

Enumeration date
05/23/2006
Last updated
12/19/2017
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