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DR. ROBERT G. WALLACE M.D.

Nuclear Radiology >> Radiology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1780015610

Individual Registrant:
DR. ROBERT G. WALLACE M.D.
Gender: M
Sole Proprietor

Location and contact information for practice:
1130 GOAT ROCK ROAD  FORTSON, GA 31808 US
Tel: 706-323-6485  Fax: 706-596-2025

Contact information for business:
P.O. BOX 2787  COLUMBUS, GA 31902 US
Tel: 706-323-6485  Fax: 706-596-2025

Registration Information:
NPI: 1780015610
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N2085N0904XAllopathic & Osteopathic Physicians
Radiology
Nuclear Radiology
GA13317
Y2085R0202XAllopathic & Osteopathic Physicians
Radiology
GA13317
N2085U0001XAllopathic & Osteopathic Physicians
Radiology
GA13317

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS GA - Page 1



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