Individual
DR. LOGAN LAUDERDALE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
(423) 431-6111
Mailing address
400 N STATE OF FRANKLIN RD, JOHNSON CITY, TN 37604-6035
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/29/2021
Last updated
06/22/2025
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