Wallace, Terrell Richard
Wallace, Terrell Richard is an individual health care provider with primary practice located at 136 South Houston Lake Road , Warner Robins GA 31088. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as his primary health care specialty. Wallace, Terrell Richard can be contacted via phone (478) 953-1020.Contact Information
Primary practice address
136 South Houston Lake Road
Warner Robins GA 31088
Phone: (478) 953-1020
Fax: (478) 953-5406
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 002665 | Georgia |
Profile Details
| NPI number | 1356399828 |
|---|---|
| LBN Legal business name | Wallace, Terrell Richard |
| Credentials | PA C |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 5th, 2006 |
| Last updated | Sep 18th, 2012 - about 14 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 | 1356399828 | NPPES |
| Other | DC3326 | MCR RR | |
| Other | P00162033 | MCR RR |
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