Jamie F Wallace

NPI #1205883147 in Fayetteville, Georgia

Provider Information

NPI Number: 1205883147
Entity Type: Individual
Name: Jamie F Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Pediatrics
Enumeration Date: May 27, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 735 GLYNN ST S
City: Fayetteville
State: Georgia
ZIP Code: 30214-2049
Phone: (770) 461-4126

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Pediatrics	208000000X	Primary

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