MR. Wallace Maxwell Green, PAC
NPI #1306979059 in Fayetteville, Georgia
Provider Information
- NPI Number
- 1306979059
- Entity Type
- Individual
- Name
- MR. Wallace Maxwell Green, PAC
- Gender
- Not Specified
- Sole Proprietor
- No
- Primary Specialty
- Psychiatry & Neurology - Neurology
- Credential
- PAC
- Enumeration Date
- Mar 13, 2007
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 1275 HIGHWAY 54 W
- Address 2
- STE.105
- City
- Fayetteville
- State
- Georgia
- ZIP Code
- 30214-4549
- Phone
- (770) 719-2965
Specialties & Taxonomy Codes
| Specialty |
|---|
| Psychiatry & Neurology - Neurology — Neurology |
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