Healthcare Provider Details

I. General information

NPI: 1477762607
Provider Name (Legal Business Name): MONROE VETERINARY CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 EAST SPRING ST
MONROE GA
30655
US

IV. Provider business mailing address

1016 EAST SPRING ST
MONROE GA
30655
US

V. Phone/Fax

Practice location:
  • Phone: 770-267-3690
  • Fax: 770-267-0761
Mailing address:
  • Phone: 770-267-3690
  • Fax: 770-267-0761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number1699
License Number StateGA

VIII. Authorized Official

Name: MR. THOMAS HENRY WALL
Title or Position: PRESIDENT
Credential: DVM
Phone: 770-267-3690