Individual
DR. WILLIAM FREDRICK WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11700 MERCY BLVD, BUILDING 6, SAVANNAH, GA 31419-1753
(912) 927-3434
Mailing address
11700 MERCY BLVD, BLVD 6, SAVANNAH, GA 31419-1753
(912) 927-3434
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
060513
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1700920154
MEDICARE RAILROAD
GA
05
—
581114452A
—
GA
Enumeration date
02/19/2007
Last updated
11/27/2012
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