Wallace, Katherine Marie

Wallace, Katherine Marie is an individual health care provider with primary practice located at 118 Enterprise Ct Ste B , Columbus GA 31904-9228. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Adult Health, which is considered as her primary health care specialty. Wallace, Katherine Marie can be contacted via phone (706) 330-1389.

Contact Information

Primary practice address
118 Enterprise Ct Ste B Columbus GA 31904-9228
Phone: (706) 330-1389
Fax: (706) 330-1392
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X A0714020 Alabama
Physician Assistants & Advanced Practice Nursing Providers / Adult Health 363LA2200X RN243697 Georgia

Profile Details

NPI number 1548650617
LBN Legal business name Wallace, Katherine Marie
Credentials NP-C
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 28th, 2015
Last updated Jul 21st, 2022 - about 3 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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Identifiers

StateTypeNumberIssuer
All States NPI 1548650617 NPPES
Georgia MEDICAID 003161276B

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