Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. ROBERT G. WALLACE, M.D.
Active Sole ProprietorDR. ROBERT G. WALLACE, M.D. is a Diagnostic Radiology healthcare provider located in FORTSON, Georgia. NPI 1780015610 is currently active in the NPPES registry. Verify at CMS.
Diagnostic Radiology · FORTSON, GA
Registration Details
- NPI Number
- 1780015610
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Dec 3, 2013 (12.72989588953 yrs)
- Last Updated
- Dec 3, 2013
- Licenses
-
13317 (GA)13317 (GA)13317 (GA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
1130 GOAT ROCK ROADFORTSON, GA, 31808Browse GA providers · Browse ZIP 31808
- Phone
- 7063236485
- Fax
- 7065962025
- Primary Specialty
-
Diagnostic Radiology
2085R0202X
- Additional Specialty
- Diagnostic Radiology
- Additional Specialty
- Diagnostic Ultrasound
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.