Search › Georgia › 363AM0700X
Ellis Wallace, PA-C
NPI 1538241815 · on the registry since 2006
Practice
- Address
- 1061 Harmon Ave
Fort Stewart, GA 31314 - Phone
- (912) 435-6633
- Fax
- (912) 435-5379
- Organisation at this address
- U.S. Army
Federal Government
Ach Winn-Ft Stewart
Winn Army Community
Ach Winn-Ft StewartInferred from a shared address, not stated in the registry. - Clinicians at this address
- 1,116
Registry record
- Primary taxonomy
- 363AM0700X
363AM0700X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2011-03-10
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Georgia