Healthcare Provider Details

I. General information

NPI: 1831024595
Provider Name (Legal Business Name): ALLISON LEE WALL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2989 W ROCK QUARRY RD
BUFORD GA
30519-4118
US

IV. Provider business mailing address

200 TOWER TER
CORNELIA GA
30531-3839
US

V. Phone/Fax

Practice location:
  • Phone: 770-932-4753
  • Fax:
Mailing address:
  • Phone: 706-768-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN294587
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: