Wallace, Jamie F
Wallace, Jamie F is an individual health care provider with primary practice located at 735 Glynn St S , Fayetteville GA 30214-2049. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Wallace, Jamie F can be contacted via phone (770) 461-4126.Contact Information
Primary practice address
735 Glynn St S
Fayetteville GA 30214-2049
Phone: (770) 461-4126
Fax: (770) 461-8852
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 043044 | Georgia |
Profile Details
| NPI number | 1205883147 |
|---|---|
| LBN Legal business name | Wallace, Jamie F |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 27th, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1205883147 | NPPES |
| Georgia | MEDICAID | 00794483A |
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