Freda Ellen Wall PA-C

NPI 1063417608 - Physician Assistant - 363A00000X

NPI Details
NPI 1063417608
Gender Female
Enumeration Date 06/20/2005
Last Updated 10/22/2007
Entity Type Individual
Active Over 11 years ago
Practice Location
2001 PEACHTREE RD NE
STE 645
ATLANTA GA, 30309-1476, US
Phone (404) 350-0106
Fax (404) 350-0176
Business Location
2001 PEACHTREE RD NE
STE 645
ATLANTA GA, 30309-1476, US
Phone (404) 350-0106
Fax (404) 350-0176
Toxanomy
Taxonomy Code 363A00000X
License State Georgia
License Number 002766
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According to our database, Freda Ellen Wall PA-C NPI is 1063417608, taxonomy code is 363A00000X and license number is 002766, license state is located at Georgia. Freda Ellen Wall PA-C physically located at 2001 Peachtree Rd Ne, Atlanta GA, 30309-1476. NPI Number Freda Ellen Wall PA-C has the Individual type.

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1063417608 NPI number is provided on an as is basis without warranty of any kind. 1063417608 is maintained by the National Plan & Provider Enumeration System. The contents of Freda Ellen Wall PA-C are for informational purposes only.