Wallace, Marlyn M.

Wallace, Marlyn M. is an individual health care provider with primary practice located at 3073 Klondike Rd Sw , Conyers GA 30094-5660. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, which is considered as her primary health care specialty. Wallace, Marlyn M. can be contacted via phone (678) 558-3106.

Contact Information

Primary practice address
3073 Klondike Rd Sw Conyers GA 30094-5660
Phone: (678) 558-3106
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X RN182038 Georgia

Profile Details

NPI number 1144790973
LBN Legal business name Wallace, Marlyn M.
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2018
Last updated Dec 5th, 2018 - about 8 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.

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