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1124087879
STEPHANIE R WALLACE
ATHENS, GA
NPI
1124087879
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363L00000X Nurse Practitioner
(Licence: GA RN136273)
Enumeration Date
2006-03-21
Last Update Date
2024-01-15
Business Address
STEPHANIE R WALLACE NP
1230 BAXTER ST
ATHENS, GA 30606-3712
Phone number: 706-389-2273
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Mailing Address
STEPHANIE R WALLACE NP
PO BOX 48089
ATHENS, GA 30604-8089
Phone number: 706-389-3740
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