Individual
BRADLEY A WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
49 JESSE HILL JR DR SE, ATLANTA, GA 30303-3049
(404) 251-8850
Mailing address
49 JESSE HILL JR DR SE, ATLANTA, GA 30303-3049
(404) 251-8850
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
075946
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
GA
Other
Enumeration date
04/01/2013
Last updated
06/20/2016
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