Provider Demographics
NPI:1962566133
Name:WALLACE D. MAYS, MD, PC
Entity type:Organization
Organization Name:WALLACE D. MAYS, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAYS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-928-2900
Mailing Address - Street 1:PO BOX 289
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-0289
Mailing Address - Country:US
Mailing Address - Phone:229-928-2900
Mailing Address - Fax:229-928-2682
Practice Address - Street 1:151 MAYO ST
Practice Address - Street 2:SUITE B
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3735
Practice Address - Country:US
Practice Address - Phone:229-928-2900
Practice Address - Fax:229-928-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA8398207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP623Medicare PIN