Waller, Alan S

Waller, Alan S is an individual health care provider with primary practice located at 100 Mimosa Drive , Thomasville GA 31792. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Surgery. Allopathic & Osteopathic Physicians / Surgery is his primary health care specialty. Waller, Alan S can be contacted via phone (229) 226-8881.

Contact Information

Primary practice address
100 Mimosa Drive Thomasville GA 31792
Phone: (229) 226-8881
Fax: (229) 225-2165
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 018761 Georgia
Allopathic & Osteopathic Physicians / Surgery 208600000X 018761 Georgia

Profile Details

NPI number 1962481226
LBN Legal business name Waller, Alan S
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 13th, 2006
Last updated Jun 25th, 2015 - about 10 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 1962481226 NPPES
Georgia Other 000394732A PEACH STATE
Georgia MEDICAID 000394732A PEACH STATE
Georgia Other 207450 PEACH STATE
Georgia MEDICAID 000394732G PEACH STATE
Georgia Other 110153553 PEACH STATE

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