DR. JEFFREY ROBERT WALLACE (NPI# 1306006796) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306006796 |
| Entity Type | Individual |
| Full Name | DR. JEFFREY ROBERT WALLACE |
| Credential | D.D.S |
| Practice Address |
1365 Clifton Rd Ne Building B Suite 2300 Atlanta GA 30322-1013 |
| Mailing Address |
44 Peachtree Pl Nw Unit 722 Atlanta GA 30309-5408 |
| Practice Telephone | 4047784500 |
| Mailing Telephone | 4048404945 |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629089156 | Jeffrey S Wallace | Orthopaedic Surgery | 6800 Heritage Pkwy Ste 102, Rockwall, TX 75087-8746 | 2006-08-10 |
| 1821014838 | Jeffrey W Wallace | Dentist | 74 Grafton Rd, Townshend, VT 05353-0262 | 2006-07-14 |
| 1568499234 | Jeffrey A. Wallace I | Pharmacist | 5420 Lancaster Dr, Kaiser Permanente Pharmacy Administration, Brooklyn Heights, OH 44131-1832 | 2006-06-27 |
| 1679563928 | Jeffrey David Wallace | Chiropractor | 820 Charlevoix Dr, Suite 210, Grand Ledge, MI 48837-8188 | 2005-10-27 |
| 1548262108 | Jeffrey Leigh Wallace | Preventive Medicine | 411 N Section St, Fairhope, AL 36532-2649 | 2005-08-12 |
| 1538557012 | Jeffrey Eugene Wallace | Counselor | 400 S Jefferson St Ste 200, Spokane, WA 99204-3143 | 2015-01-06 |
| 1619392974 | Jeffrey Michael Wallace | Physician Assistant | 600 Caisson Hill Rd, Fort Riley, KS 66442-7037 | 2014-02-24 |
| 1649479171 | Jeffrey W Wallace | Physician Assistant | 112 Piper Hill Dr, First Floor, Saint Peters, MO 63376-1690 | 2007-07-14 |
| 1215027990 | Jeffrey Wallace | Internal Medicine | 12605 E 16th Ave, Aurora, CO 80045-2545 | 2006-10-13 |
| 1003866419 | Jeffrey Neil Wallace | Chiropractor | 330 140 Village Rd, Unit 9a, Westminster, MD 21157-6127 | 2006-05-10 |
| Street Address |
1365 CLIFTON RD NE BUILDING B SUITE 2300 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30322-1013 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124022637 | Richard Duszak Jr. | Radiology | 1365 Clifton Rd Ne, Emory University Department of Radiology, Atlanta, GA 30322-1013 | 2005-06-13 |
| 1891319091 | Kayla Sondria Freeman | Registered Nurse | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2020-06-03 |
| 1548881576 | Rachelle Leona Rouse | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2020-04-30 |
| 1982233227 | Kayla Anne Nichols | Pharmacist | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2020-04-08 |
| 1326675380 | Tankeia Tanye' Warren | Nurse Practitioner | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2020-03-26 |
| 1407488687 | Bethany Joan Hanscom | Physician Assistant | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2020-02-06 |
| 1518505577 | Juanjuan Wu | Nurse Practitioner | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2019-12-20 |
| 1942847587 | Nour Majed Moukalled | Internal Medicine | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2019-12-02 |
| 1528604816 | Tram Bao Vu | Physician Assistant | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2019-11-21 |
| 1083266845 | Desiree Morgan Rogers | Nurse Practitioner | 1365 Clifton Rd Ne, Atlanta, GA 30322-1013 | 2019-07-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700445830 | Justin Gill | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne, Clinic B - Suite B6100, Atlanta, GA 30322 | 2019-06-12 |
| 1891354510 | Gwendolyn Gisiner Gunn | Genetic Counselor, MS | Emory Genetics Clinic, 1365 Clifton Road Ne, Atlanta, GA 30322 | 2019-06-06 |
| 1144710567 | Lisa Cathy-ann Akosa | Registered Nurse | 1365 Cifton Road Ne, Atlanta, GA 30322 | 2018-05-10 |
| 1083118004 | Jessica Milian Keilson | Student in an Organized Health Care Education/Training Program | 1364 Clifton Road Ne, Suite H100, Emory University Hospital Office of Surgical Education, Atlanta, GA 30322 | 2018-03-23 |
| 1568982684 | Jennifer Bilko | Dietitian, Registered | 1365 Clifton Rd., Bldg A, 1st Floor, Suite 1450, Atlanta, GA 30322 | 2017-06-20 |
| 1134652258 | Kassahun Bilcha | Student in an Organized Health Care Education/Training Program | 1525 Clifton Rd Ne Ste 100, Atlanta, GA 30322 | 2017-04-05 |
| 1356872246 | Tova Rogers | Dermatology | 1525 Clifton Road Suite 105, Atlanta, GA 30322 | 2017-03-23 |
| 1194271445 | Dina Amin | Dentist | 1365 Clifton,building B, Oral and Maxillofacial Surgery, Suite 2300, Atlanta, GA 30322 | 2016-08-28 |
| 1427404904 | Rita Kaur Kuwahara | Student in an Organized Health Care Education/Training Program | 100 Woodruff Circle, Suite 327, Atlanta, GA 30322 | 2016-05-13 |
| 1891176251 | Octav Cristea | Transplant Surgery | 1365 Clifton Road Northeast, Building B, 6th Floor, Atlanta, GA 30322 | 2015-06-11 |
| Find all providers in zip 30322 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417563909 | Josephine Almanzar | Student in an Organized Health Care Education/Training Program | 199 Armour Dr Ne Ste E, Atlanta, GA 30324-3973 | 2020-09-20 |
| 1013532597 | Ivy Elizabeth Cook | Student in an Organized Health Care Education/Training Program | 3121 Flowers Rd S Apt I, Atlanta, GA 30341-5648 | 2020-06-10 |
| 1265055495 | Jeffrey Quinn Taylor II | Student in an Organized Health Care Education/Training Program | 1365 Clifton Rd Ne # 2300b, Atlanta, GA 30322-1013 | 2020-05-21 |
| 1073134391 | Robert Shvarts | Student in an Organized Health Care Education/Training Program | 465 Memorial Dr Se Unit 346, Atlanta, GA 30312-2229 | 2020-04-27 |
| 1477173920 | Ryan William Flanagan | Student in an Organized Health Care Education/Training Program | 2591 Piedmont Rd Ne Apt 1531, Atlanta, GA 30324-6280 | 2020-04-24 |
| 1467071589 | Charles Thomas Reeder | Student in an Organized Health Care Education/Training Program | 1744 Logans Knl Ne, Atlanta, GA 30329-4100 | 2020-04-09 |
| 1548899743 | Chandni Patel | Student in an Organized Health Care Education/Training Program | 700 14th St Nw, Atlanta, GA 30318-5408 | 2020-04-08 |
| 1962031625 | Rachel Reed | Student in an Organized Health Care Education/Training Program | 1364 Clifton Rd Ne Ste H-100, Atlanta, GA 30322-1059 | 2020-04-05 |
| 1629606264 | Jasmine Donesha Shackelford | Student in an Organized Health Care Education/Training Program | Emory Family Medicine, 4500 North Shallowford Road, Atlanta, GA 30338 | 2020-03-30 |
| 1467080218 | Aminah Danielle Phelps | Student in an Organized Health Care Education/Training Program | 395 Saint Jacques Ct Sw, Atlanta, GA 30331-8434 | 2020-03-28 |
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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.