Wallace, William Fredrick
Wallace, William Fredrick is an individual health care provider with primary practice located at 11700 Mercy Blvd Building 6, Savannah GA 31419-1753. He recently has only one registered license in Allopathic & Osteopathic Physicians / Interventional Cardiology, which is considered as his primary health care specialty. Wallace, William Fredrick can be contacted via phone (912) 927-3434.Contact Information
Primary practice address
11700 Mercy Blvd Building 6
Savannah GA 31419-1753
Phone: (912) 927-3434
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Interventional Cardiology | 207RI0011X | 060513 | Georgia |
Profile Details
| NPI number | 1700920154 |
|---|---|
| LBN Legal business name | Wallace, William Fredrick |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 19th, 2007 |
| Last updated | Nov 27th, 2012 - about 13 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1700920154 | NPPES |
| Georgia | MEDICAID | 581114452A | |
| Georgia | Other | 1700920154 |
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