Individual
DR. ROBERT G. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1130 GOAT ROCK ROAD, FORTSON, GA 31808
(706) 323-6485
(706) 596-2025
Mailing address
P.O. BOX 2787, COLUMBUS, GA 31902
(706) 323-6485
(706) 596-2025
Taxonomy
Speciality
Code
Description
License number
State
2085N0904X
Nuclear Radiology Physician
13317
GA
2085R0202X
Diagnostic Radiology Physician
Primary
13317
GA
2085U0001X
Diagnostic Ultrasound Physician
13317
GA
Other
Enumeration date
12/03/2013
Last updated
12/03/2013
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