NPI 1053822999

Jahqwale Wallace

Practitioner Contractor Valdosta, GA

Practice location

Address: 1501 Myrtle St APT C3, Valdosta, GA 31601-3071
Phone: (912) 704-9805

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X

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Registry record

NPI: 1053822999
Entity type: Individual
Sex (as registered): Female
NPI issued: 18 Oct 2017
Record last updated: 18 Oct 2017

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.