JACOB WALLIS

FAYETTEVILLE, GA
NPI1568118172
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: TN  4879)
Enumeration Date2022-02-23
Last Update Date2024-11-21
Business Address
JACOB WALLIS
104 N PARK DR
FAYETTEVILLE, GA 30214-1645
Phone number: 470-944-5290
Mailing Address
JACOB WALLIS
206 OXFORD RD
NEW ALBANY, MS 38652-3115
Phone number: 662-534-2227
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