Search › Georgia › 363A00000X
Jacob Wallis
NPI 1568118172 · on the registry since 2022
Practice
- Address
- 104 N Park Dr
Fayetteville, GA 30214 - Phone
- (470) 944-5290
- Organisation at this address
- Orthoxpress Of Georgia
Inferred from a shared address, not stated in the registry.
- Clinicians at this address
- 2
Additional practice sites
- 60 John C Breckenridge Cv, Adamsville, TN
- 6515 Poplar Ave Ste 106, Memphis, TN
Registry record
- Primary taxonomy
- 363A00000X
363A00000X
- Licence states on file
- TN
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2024-11-21
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