IndividualActive
Heather Wallace
NPI 1053856427 · Gerontology Nurse Practitioner · Macon, GA
Provider details
- NPI number
- 1053856427
- Entity type
- Individual
- Primary specialty
- Gerontology Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Sex
- Female
- Sole proprietor
- No
- License
- RN197918 (GA)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
535 Coliseum Dr
Macon, GA 31217-0104
Phone: (478) 972-0277
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 26698
Macon, GA 31221-6698
Registry dates
- Enumerated
- 2016-12-21
- Last updated
- 2016-12-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.