Shantonitt Wallace

NPI #1477262590 in Valdosta, Georgia

Provider Information

NPI Number: 1477262590
Entity Type: Individual
Name: Shantonitt Wallace
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Contractor
Enumeration Date: Nov 17, 2022
Last Updated: Nov 17, 2022

Practice Location

Address: 2209 PULASKI CIR
City: Valdosta
State: Georgia
ZIP Code: 31602-7312
Phone: (229) 618-0021

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Contractor	171W00000X	Primary

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