NPI 1003339094

Trevor Dewitt Wallace

Practitioner Contractor Suwanee, GA

Practice location

Address: 571 Eva Kennedy Rd APT 8, Suwanee, GA 30024-3008
Phone: (770) 369-1497

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1003339094
Entity type: Individual
Sex (as registered): Male
NPI issued: 20 Jul 2017
Record last updated: 21 Jul 2022

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.