Individual
DR. MICHAEL LEE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
950 SANDERS RD, CUMMING, GA 30041-5960
(770) 889-5030
(770) 889-5030
Mailing address
950 SANDERS ROAD, CUMMING, GA 30041-6183
(770) 889-5030
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
54290
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
938550931A
—
GA
Enumeration date
08/09/2006
Last updated
06/13/2011
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