NPI
Jonathan David Wallace
This page is a copy of the public NPPES file.
Facts
- Status
- Active
- Credential
- LOTR
- Type
- Individual
- Enumeration date
- 2022-07-25
- Last updated
- 2022-07-25
Specialties
Licenses
- License LA
- OTT.Z12243
Location
- Practice location
- 870 Highway 516
- City
- Heflin LA
- Postal code
- 71039-3726
- Phone
- (318) 614-5684
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. OIG's online search is the official check.
Nearby
Other NPIs in Heflin, LA. 7 records in the public file.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.
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