Douglas W Wallace MD

NPI 1083608053 - Radiology - 2085R0202X

NPI Details
NPI 1083608053
Gender Male
Enumeration Date 09/07/2005
Last Updated 07/27/2015
Entity Type Individual
Active Over 11 years ago
Practice Location
2300 MANCHESTER EXPY
STE A001
COLUMBUS GA, 31904-6802, US
Phone (706) 257-7700
Fax (706) 257-7708
Business Location
P.O. BOX 9145
COLUMBUS GA, 31908-9145, US
Phone (706) 257-7700
Fax (706) 257-7708
Toxanomy
Taxonomy Code 2085R0202X
License State Georgia
License Number 14966
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According to our database, Douglas W Wallace MD NPI is 1083608053, taxonomy code is 2085R0202X and license number is 14966, license state is located at Georgia. Douglas W Wallace MD physically located at 2300 Manchester Expy, Columbus GA, 31904-6802. NPI Number Douglas W Wallace MD has the Individual type.

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1083608053 NPI number is provided on an as is basis without warranty of any kind. 1083608053 is maintained by the National Plan & Provider Enumeration System. The contents of Douglas W Wallace MD are for informational purposes only.