Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Wallace Maxwell Green, PAC

Individual provider Neurology Physician · NPI 1306979059

Mr. Wallace Maxwell Green, PAC is a Neurology Physician in Fayetteville, Georgia. Licensed in Georgia. Registered with an NPI since 2007.

Licensed in
GA
In the registry since
2007
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

1275 Highway 54 W STE.105
Fayetteville, GA 30214-4549
Phone: (770) 719-2965
Fax: (770) 719-2963
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neurology Physician (primary) Taxonomy 2084N0400X · Licence 001827 (GA)

Record details

NPI number1306979059
Entity typeIndividual (Type 1)
GenderMale
Credentials PAC
Sole proprietorNo
NPI enumeratedMarch 13, 2007
Last updated in NPPESJuly 8, 2007

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