Wallace, Douglas W

Wallace, Douglas W is an individual health care provider with primary practice located at 2300 Manchester Expy Ste A001, Columbus GA 31904-6802. He recently has only one registered license in Allopathic & Osteopathic Physicians / Diagnostic Radiology, which is considered as his primary health care specialty. Wallace, Douglas W can be contacted via phone (706) 257-7700.

Contact Information

Primary practice address
2300 Manchester Expy Ste A001 Columbus GA 31904-6802
Phone: (706) 257-7700
Fax: (706) 257-7708
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 14966 Georgia
Allopathic & Osteopathic Physicians / Diagnostic Radiology 2085R0202X 014966 Georgia

Profile Details

NPI number 1083608053
LBN Legal business name Wallace, Douglas W
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 7th, 2005
Last updated Jul 27th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1083608053 NPPES
Georgia MEDICAID 003139318A
Georgia MEDICAID 141177
Georgia Other 202I307506

Popular Providers