Individual
DR. JEFFREY ROBERT WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S
Contact information
Practice address
1365 CLIFTON RD NE, BUILDING B SUITE 2300, ATLANTA, GA 30322-1013
(404) 778-4500
Mailing address
44 PEACHTREE PL NW, UNIT 722, ATLANTA, GA 30309-5408
(404) 840-4945
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/10/2008
Last updated
06/10/2008
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