Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
TREVOR DEWITT WALLACE
Active Sole ProprietorTREVOR DEWITT WALLACE is a Contractor healthcare provider located in SUWANEE, Georgia. NPI 1003339094 is currently active in the NPPES registry. Verify at CMS.
Contractor · SUWANEE, GA
Registration Details
- NPI Number
- 1003339094
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jul 20, 2017 (9.0887734274488 yrs)
- Last Updated
- Jul 21, 2022
- Sole Proprietor
- Yes
Practice Information
- Address
-
571 EVA KENNEDY RD APT 8SUWANEE, GA, 300243008Browse GA providers · Browse ZIP 30024
- Phone
- 7703691497
- Primary Specialty
-
Contractor
171W00000X
Other Contractor Providers in SUWANEE, GA
| Name | Credential | NPI |
|---|---|---|
| TRACIE R VALERA | CEO | 1023620093 |
| ASHLEY CALDWELL | — | 1407613839 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.