Search › Georgia › 2084N0400X
Wallace Green, PAC
NPI 1306979059 · on the registry since 2007
Practice
- Address
- 1275 Highway 54 W
Ste.105
Fayetteville, GA 30214 - Phone
- (770) 719-2965
- Fax
- (770) 719-2963
- Organisation at this address
- Crh
Martha A Schuh, Md
Georgia Urology Pa
J. Rena Owsley-Brown
Sleep Services Of AmericaInferred from a shared address, not stated in the registry. - Clinicians at this address
- 35
Registry record
- Primary taxonomy
- 2084N0400X
2084N0400X
- Licence states on file
- GA
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
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