Marlyn M. Wallace

Nurse Practitioner · Conyers, GA

Individual Active NPI

NPI number 1144790973

Practice location

3073 Klondike Rd SW
Conyers, GA 30094-5660
Phone
(678) 558-3106

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NPI record

NPI
1144790973
Entity type
Individual (Type 1)
Enumeration date
December 5, 2018
Last updated
December 5, 2018
Sole proprietor
No

Specialties & taxonomy codes

TaxonomyCodeLicenseState
Nurse Practitioner Primary 363L00000X RN182038 GA

About Marlyn Wallace

Marlyn M. Wallace is a healthcare provider registered in the NPI registry with the primary taxonomy Nurse Practitioner (code 363L00000X). The practice location is 3073 Klondike Rd SW, Conyers, GA 30094-5660. The NPI number 1144790973 was assigned on December 5, 2018 and the record was last updated on December 5, 2018.

Marlyn Wallace lists a license in the registry: #RN182038 (GA) for Nurse Practitioner. License numbers are self-reported to NPPES; verify them with the state licensing board.

Frequently asked questions

What is the NPI number of Marlyn M. Wallace?

The NPI number is 1144790973.

What is the phone number of Marlyn Wallace?

The phone number listed for the practice location is (678) 558-3106.

Where is Marlyn Wallace located?

3073 Klondike Rd SW, Conyers, GA 30094-5660.

What is the taxonomy code for Marlyn Wallace?

The primary taxonomy code is 363L00000X – Nurse Practitioner.

Is this information correct?

All details come from the public NPPES registry. Providers can update their record at nppes.cms.hhs.gov; changes appear here after the next weekly update.

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