person
Mr. Terrell Richard Wallace JR., PAC
Medical Physician Assistant in Warner Robins, Georgia
NPI 1356399828

Terrell Richard Wallace JR. is a Medical Physician Assistant based in Warner Robins, GA and is specialized in Medical. Terrell Richard Wallace JR. practices in Warner Robins, GA and has the professional credentials of PAC. The NPI Number for Terrell Richard Wallace JR. is 1356399828 and holds a License No. 002665 (Georgia).

The current practice location address for Terrell Richard Wallace JR. is 136 South Houston Lake Road, Warner Robins, GA and can be reached out via phone at 478-953-1020 and via fax at 478-953-5406. You can also correspond with Terrell Richard Wallace JR. through the mailing address at 207 ESPLANADE DRIVE, WARNER ROBINS, GA - 31088 (mailing address contact number: 478-922-3061).

Location: 136 South Houston Lake Road, Warner Robins, GA, 31088
person
Provider Profile Details
NPI Number
1356399828
Provider Name
Terrell Richard Wallace JR.
Credential
PAC
Provider Entity Type
Individual
Gender
Male
Address
136 South Houston Lake Road, Warner Robins, GA, 31088
Phone Number
478-953-1020
Fax Number
478-953-5406
Provider Enumeration Date
05/05/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
DC3326 01 MCR RR
P00162033 01 MCR RR
institution
Provider Business Practice Location Address Details
Address
136 South Houston Lake Road
City
State
Zip
31088
Phone Number
478-953-1020
Fax Number
478-953-5406
person
Provider Business Mailing Address Details
Address
207 Esplanade Drive
City
State
Zip
31088
Phone Number
478-922-3061
Fax Number
478-953-5406
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
License No.
002665 (Georgia)
Definition
Definition to come...
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