Wallace, Amanda Daniel

Wallace, Amanda Daniel is an individual health care provider with primary practice located at 655 Jesse Jewell Pkwy Se Ste B , Gainesville GA 30501-3854. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is her primary health care specialty. Wallace, Amanda Daniel can be contacted via phone (770) 532-7092.

Contact Information

Primary practice address
655 Jesse Jewell Pkwy Se Ste B Gainesville GA 30501-3854
Phone: (770) 532-7092
Fax: (770) 536-0383
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 6247 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X 6247 Georgia
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 6247 Georgia

Profile Details

NPI number 1518249838
LBN Legal business name Wallace, Amanda Daniel
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 13th, 2011
Last updated Sep 26th, 2023 - about 2 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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