Individual
DR. MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
202 VILLAGE CENTER PKWY, STOCKBRIDGE, GA 30281-9044
(404) 256-2593
(770) 488-9408
Mailing address
2970 BRANDYWINE RD STE 125, ATLANTA, GA 30341-5521
(404) 256-2593
(770) 488-9408
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
141727
NC
2080P0202X
Pediatric Cardiology Physician
Primary
064090
GA
Other
Enumeration date
04/16/2008
Last updated
04/30/2026
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