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1700562766
CARLY WALLACE
AUGUSTA, GA
NPI
1700562766
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: GA 15182)
Enumeration Date
2023-06-26
Last Update Date
2023-06-29
Business Address
CARLY WALLACE DO
1120 15TH STREET BI5070
AUGUSTA, GA 30912
Phone number: 706-721-2423
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Mailing Address
CARLY WALLACE DO
1120 15TH STREET BI5070
AUGUSTA, GA 30912
Phone number: 706-721-2423
Copy
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