Candice Charlene Walllace, CSFA
Specialist/Technologist, Other, Surgical Assistant in Calhoun, GA. Individual provider (NPI-1).
NPI number1407442197
StatusActive
Last updated in NPPESDec 16, 2020
Details
- NPI
- 1407442197
- Entity type
- Individual (NPI-1)
- Name
- Candice Charlene Walllace
- Credential
- CSFA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Dec 16, 2020
- Certification date
- Dec 15, 2020
- Last updated
- Dec 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 246ZC0007X | Specialist/Technologist, Other, Surgical Assistant | – | – | Yes |
Practice location
1035 Red Bud Rd NeCalhoun, GA 30701-6010
Phone 706-602-7800
Mailing address
210 Gwen DrRinggold, GA 30736-6120
Phone 423-762-7603
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