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
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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
Mailing address1275 Highway 54 W, Ste.105, Fayetteville, GA 30214-4549

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