DR. MICHELLE WALLACE (NPI# 1316111719) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316111719 |
| Entity Type | Individual |
| Full Name | DR. MICHELLE WALLACE |
| Credential | M.D. |
| Practice Address |
2835 Brandywine Rd Suite 300 Atlanta GA 30341-5540 |
| Practice Telephone | 7704889212 |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2010-04-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208000000X | Pediatrics | 141727 | NC | Allopathic & Osteopathic Physicians |
| Y | 2080P0202X |
Pediatrics Specialization: Pediatric Cardiology |
064090 | GA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770051252 | Michelle Wallace | Technician | 1515 Sumac Rd, Fort Gibson, OK 74434-7512 | 2018-11-02 |
| 1437524196 | Michelle Wallace | Physical Therapist | 473 Auxier Dr, Cincinnati, OH 45244-2364 | 2015-12-07 |
| 1497091805 | Michelle Lynn Wallace | Specialist | 508 Blair Blvd, Eugene, OR 97402-4630 | 2012-12-13 |
| 1477808947 | Michelle Wallace | Physical Medicine & Rehabilitation | 75 Norman Pl, Tenafly, NJ 07670-2537 | 2012-07-19 |
| 1598884272 | Michelle Marie Wallace I | Registered Nurse | 17887 State Route 58, Wellington, OH 44090-9464 | 2007-03-27 |
| 1336796374 | Michelle Wallace | Counselor | 369 Ne Revere Ave Ste 101, Bend, OR 97701-4082 | 2019-08-23 |
| 1316471790 | Michelle Dianne Wallace | Nurse Practitioner | 8970 S Meridian St, Indianapolis, IN 46217-5031 | 2017-04-12 |
| 1972044519 | Michelle D Wallace | Durable Medical Equipment & Medical Supplies | 9701 Apollo Dr Ste 100, Largo, MD 20774-4785 | 2017-03-15 |
| 1275938185 | Michelle Mayer Wallace | Pharmacist | 2413 Highway 431 North, Anniston, AL 36206 | 2014-11-04 |
| 1912249822 | Michelle M Wallace | Physical Therapist | 2300 Trenton Rd, Levittown, PA 19056-1423 | 2013-03-19 |
| Street Address |
2835 BRANDYWINE RD SUITE 300 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30341-5540 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548262967 | Chad Mao | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5540 | 2005-08-15 |
| 1851612261 | Divya Suthar | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2010-06-21 |
| 1073756631 | Holly Bauser-heaton | Pediatrics | 2835 Brandywine Rd, Suite 400, Atlanta, GA 30341 | 2009-04-13 |
| 1164692174 | Usama B Kanaan | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5540 | 2008-03-05 |
| 1972787760 | Glen Joseph Iannucci | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2007-12-28 |
| 1568661767 | Timotheus George Watson | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2007-07-17 |
| 1235336538 | Fred Henry Rodriguez IIi | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2007-06-29 |
| 1538377502 | Benjamin J Toole | Emergency Medicine | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2007-05-21 |
| 1154539385 | Brandon W Harden | Emergency Medicine | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2007-05-20 |
| 1124233606 | Matthew Eric Ferguson | Pediatrics | 2835 Brandywine Rd, #300, Atlanta, GA 30341-5540 | 2007-05-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992207344 | Rabun Marie Robertson | Occupational Therapist | 2320 Perimeter Park Drive, Atlanta, GA 30341 | 2018-03-01 |
| 1568986313 | Charles Edge IIi | Nurse Practitioner | 4770 Buford Highway, Atlanta, GA 30341 | 2017-08-02 |
| 1366971277 | Park Ridge Healthcare and Physical Medicine LLC | Nurse Practitioner | 2896 Chamblee Tucker Road, Suite 4, Atlanta, GA 30341 | 2017-06-06 |
| 1437502937 | Chara Mcgill | Counselor | 13207 Jefferson Circle N, Chamblee, GA 30341 | 2016-07-20 |
| 1982063913 | Stepping Stone of Atlanta | Community/Behavioral Health | 3705 Chamblee Dunwoody Rd, Chamblee, GA 30341 | 2016-02-18 |
| 1013317577 | Marne Day | Counselor | 3720 Chamblee Dunwoody Rd, Chamblee, GA 30341 | 2014-09-02 |
| 1013343680 | Keelan Walker | Speech-Language Pathologist | 4961 Buford Highway Suite 201, Suite 201, Chamblee, GA 30341 | 2013-09-16 |
| 1578901955 | Promonitor LLC | Electrodiagnostic Medicine | 3300 Northwest Expy Bldg 7, Atlanta, GA 30341 | 2013-06-07 |
| 1639415359 | Lawanda B Cooke | Health Educator | 5280 Peachtree Ind Blvd, Chamblee, GA 30341 | 2012-12-28 |
| 1457602773 | Arthur Macrae Wendel | Family Medicine | 4770 Buford Hwy Ms F60, Atlanta, GA 30341 | 2012-09-26 |
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| Taxonomy Code | 2080P0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Cardiology |
| A pediatric cardiologist provides comprehensive care to patients with cardiovascular problems. This specialist is skilled in selecting, performing and evaluating the structural and functional assessment of the heart and blood vessels, and the clinical evaluation of cardiovascular 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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) was provided by the American Osteopathic Board of Pediatrics. The Certification is no longer offered. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366491953 | Derek A Fyfe | Pediatrics | 1405 Clifton Rd, Atlanta, GA 30322 | 2006-05-09 |
| 1548232036 | Lazaros K Kochilas | Pediatrics | 2835 Brandywine Road, Suite 300, Atlanta, GA 30341-5540 | 2006-02-07 |
| 1487008330 | Jay Patel | Pediatrics | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2016-04-18 |
| 1487099859 | James A Nelson Jr. | Pediatrics | 1405 Clifton Rd Ne, Atlanta, GA 30322-4699 | 2013-04-30 |
| 1770846149 | Michael Phillip Fundora | Pediatrics | 1405 Clifton Rd Ne, Atlanta, GA 30322 | 2012-06-20 |
| 1669762738 | Zahidee Rodriguez | Pediatrics | 1405 Clifton Rd Ne, Atlanta, GA 30322-3039 | 2011-04-11 |
| 1487943544 | Robert Dean Whitehill | Pediatrics | 5461 Meridian Marks Rd Ste 530, Atlanta, GA 30342-3283 | 2011-03-29 |
| 1851612261 | Divya Suthar | Pediatrics | 2835 Brandywine Rd, Suite 300, Atlanta, GA 30341-5510 | 2010-06-21 |
| 1841516838 | Yinn Khurn Ooi | Pediatrics | 1405 Clifton Rd Ne, Atlanta, GA 30322-1060 | 2010-04-15 |
| 1922269794 | Pediatric Cardiology Services LLC | Pediatrics | 980 Johnson Ferry Rd Ne, Suite 560, Atlanta, GA 30342-1626 | 2008-06-24 |
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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.