Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0101X | MOHS-Micrographic Surgeon | ME139741 | FL |
NPI | 1093101107 |
---|---|
Provider Name | Dr. Wallace Ramsey Nozile |
First Address | Stockbridge, GA 30281-6333 |
Second Address | Stockbridge, GA 30281-6333 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2015 |
Last Update Date | 08/11/2021 |