Individual
JAMES JOSEPH WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
154 SUGAR CANE DR, HARTWELL, GA 30643-8120
(678) 316-3604
Mailing address
154 SUGAR CANE DR, HARTWELL, GA 30643-8120
(678) 316-3604
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
080202060
GA
Other
Enumeration date
05/11/2010
Last updated
05/11/2010
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