Individual
TIMOTHY BRIAN WALLACE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
550 PEACHTREE ST NE, ATLANTA, GA 30308-2212
(404) 778-3900
Mailing address
443 E LAKE DR, DECATUR, GA 30030-3531
(912) 507-5962
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
D75606
MD
Other
Enumeration date
04/01/2009
Last updated
06/05/2019
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