Doctor Name: | JAMES WALLACE |
NPI Number: | 1033400999 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 593 Bramlett Way Powder Springs, GA - 30127 |
Business Phone Number: | 4045428944 |
Business Fax Number: | |
Mailing Address: | 593 Bramlett Way, POWDER SPRINGS |
State: | GA |
Postal Code: | 30127 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/27/2011 |
NPI Last Update Date: | 04/27/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |