DOUGLAS W WALLACE (NPI# 1083608053) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083608053 |
| Entity Type | Individual |
| Full Name | DOUGLAS W WALLACE |
| Credential | MD |
| Practice Address |
2300 Manchester Expy Ste A001 Columbus GA 31904-6802 |
| Mailing Address |
P.o. Box 9145 Columbus GA 31908-9145 |
| Practice Telephone | 7062577700 |
| Practice Fax Number | 7062577708 |
| Mailing Telephone | 7062577700 |
| Mailing Fax Number | 7062577708 |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2015-07-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
014966 | GA | Allopathic & Osteopathic Physicians |
| N | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
14966 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | MEDICARE PTAN | 202I307506 | 01 |
| AL | 141177 | 05 | |
| GA | 003139318A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376698753 | Douglas W. Wallace | Oral & Maxillofacial Surgery | 5188 Winton Rd, Fairfield, OH 45014-2900 | 2007-01-24 |
| 1063451144 | Douglas C Wallace | Family Medicine | 3154 Park St, Grove City, OH 43123-3222 | 2006-06-05 |
| 1730794041 | Douglas Wallace | Hearing Instrument Specialist | 95 Post Office Park, Wilbraham, MA 01095-1248 | 2020-09-14 |
| 1285098806 | Douglas Wallace | Emergency Medicine | 625 19th St S, Birmingham, AL 35233 | 2016-04-09 |
| 1811181498 | Douglas Cecil Wallace | Medical Genetics, Ph.D. Medical Genetics | 2014 Hewitt Hall, University of California Irvine, Irvine, CA 92697-3940 | 2007-08-28 |
| 1013058932 | Douglas Mckay Wallace | Psychiatry & Neurology | 1201 Nw 16th St, Miami Va Medical Center, Dept of Neurology, Miami, FL 33125-1624 | 2007-02-12 |
| 1851470033 | Douglas Charles Wallace | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 3900 St Francis Way, Ste 201, Lafayette, IN 47905-4923 | 2006-11-06 |
| 1881657989 | Douglas M Wallace | Emergency Medicine | 101 E Wood St, Spartanburg, SC 29303-3040 | 2006-04-10 |
| Street Address |
2300 MANCHESTER EXPY STE A001 |
| City | COLUMBUS |
| State | GA |
| Zip Code | 31904-6802 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811994403 | Sebastian O Hubbuch | Internal Medicine | 2300 Manchester Expy, Ste 1003, Columbus, GA 31904-6877 | 2005-06-28 |
| 1730615790 | Petra S Glover | Nurse Practitioner | 2300 Manchester Expy, Ste 1003, Columbus, GA 31904-6802 | 2017-05-11 |
| 1063956795 | Rebekah Begly | Nurse Practitioner | 2300 Manchester Expy, Butler Pavilion, Suite 1007, Columbus, GA 31904-6802 | 2016-12-14 |
| 1528517802 | Tracy B Stokes | Nurse Practitioner | 2300 Manchester Expy, Ste C001, Columbus, GA 31904-6802 | 2016-09-27 |
| 1073066254 | Chelsea Lawrence | Nurse Practitioner | 2300 Manchester Expy, Suite 2001, Butler Pavilion, Columbus, GA 31904-6802 | 2016-07-25 |
| 1609229863 | Dixie Peterson | Nurse Practitioner | 2300 Manchester Expy, Suite 2001, Columbus, GA 31904-6802 | 2016-07-22 |
| 1720430440 | Alexander Chavez | Nurse Practitioner | 2300 Manchester Expy, Ste 1009, Columbus, GA 31904-6802 | 2016-07-06 |
| 1437506318 | Michael Lemke | Nurse Practitioner | 2300 Manchester Expy, Building A, Suite 6, Columbus, GA 31904-6802 | 2016-05-19 |
| 1568822286 | Summer Carol Still | Nurse Practitioner | 2300 Manchester Expy, Suite 2001, Columbus, GA 31904-6802 | 2016-02-24 |
| 1861857294 | St. Francis Physician Practices LLC | Physical Medicine & Rehabilitation | 2300 Manchester Expy, Ste A005, Columbus, GA 31904-6802 | 2015-12-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821641457 | At Home Palliative Care, LLC | Nursing Care | 114 Enterprise Ct, Suite B, Columbus, GA 31904 | 2019-07-23 |
| 1285191049 | Shandra Ladell Grimes | Nurse Practitioner | 2300 Manchester Expwy St Francis Hospital, Suite C-001, Columbus, GA 31904 | 2019-02-27 |
| 1881161529 | Lesley Kathleen Simmons | Massage Therapist | 5402 15th Ave, Columbus, GA 31904 | 2018-10-31 |
| 1184190662 | Alphonsa Joseph | Nurse Practitioner | 2430 Brookstone Centre Parkway, Columbus, Georgia 31904, Columbus, GA 31904 | 2018-10-22 |
| 1568942704 | William Pearce Massey | Social Worker | 8851-1 Moore Road, Columbus, GA 31904 | 2018-08-17 |
| 1033696372 | Marlise V. Gray | Counselor | 2013 Devonshire Dr. Suite 115, Columbus, GA 31904 | 2018-07-19 |
| 1710418173 | Amanda Barnette Pruett | Behavioral Analyst | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904 | 2017-03-27 |
| 1750833232 | Carrie Leigh Whitehead | Nurse Practitioner | 6228 Bradley Park Dr. Suite A, Columbus, GA 31904 | 2016-10-31 |
| 1609323369 | Shomika Lasha Battle | Registered Nurse | 2101 North Avenue, Columbus, GA 31904 | 2016-09-09 |
| 1952759219 | Peaceful River Home Care Agency | In Home Supportive Care | 738 Rudgate Road, Columbus, GA 31904 | 2016-05-27 |
| Find all providers in zip 31904 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467964718 | Columbus Radiology Physicians LLC | Radiology | 2400 E. 17th Street, Columbus, IN 47201 | 2017-10-26 |
| 1922528595 | Advantage Imaging, LLC | Radiology | 1120 Polaris Pkwy Ste 105, Columbus, OH 43240-4042 | 2017-06-23 |
| 1710220975 | Mina S Makary | Radiology | Department of Radiology, Osu Medical Center, 395 W. 12th Ave, 4th Floor, Columbus, OH 43210 | 2013-04-05 |
| 1619236387 | Christopher Scott Davis | Radiology | 395 W 12th Ave Rm 482, Columbus, OH 43210-1267 | 2012-05-15 |
| 1144591066 | Morton I Goldstein | Radiology | 2142 Maple Bnd, Columbus, OH 43229-6809 | 2012-01-24 |
| 1447563168 | Louis Marone | Radiology | Po Box L3402, Columbus, OH 43260-0001 | 2010-07-22 |
| 1407179062 | Theresa M. March | Radiology | 4937 W Broad Street, Suite 302, Columbus, OH 43228 | 2010-03-10 |
| 1114153467 | Kerry Yolanda Cole | Radiology | 2984 Valley Creek Dr, Columbus, OH 43223-3525 | 2009-06-01 |
| 1760631105 | Frank Michael Mullinix | Radiology | 10601 W Grandview Dr, Columbus, IN 47201-8697 | 2008-09-10 |
| 1508024209 | Clinic Medical Services Company | Radiology | 1550 Kenny Rd, Columbus, OH 43212-2564 | 2008-05-29 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.