Green, Wallace Maxwell
Green, Wallace Maxwell is an individual health care provider with primary practice located at 1275 Highway 54 W Ste.105, Fayetteville GA 30214-4549. He recently has only one registered license in Allopathic & Osteopathic Physicians / Neurology, which is considered as his primary health care specialty. Green, Wallace Maxwell can be contacted via phone (770) 719-2965.Contact Information
Primary practice address
1275 Highway 54 W Ste.105
Fayetteville GA 30214-4549
Phone: (770) 719-2965
Fax: (770) 719-2963
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Neurology | 2084N0400X | 001827 | Georgia |
Profile Details
| NPI number | 1306979059 |
|---|---|
| LBN Legal business name | Green, Wallace Maxwell |
| Credentials | PAC |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 13th, 2007 |
| Last updated | Jul 8th, 2007 - about 18 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.
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