DR. ROBERT G. WALLACE (NPI# 1780015610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780015610 |
| Entity Type | Individual |
| Full Name | DR. ROBERT G. WALLACE |
| Credential | M.D. |
| Practice Address |
1130 Goat Rock Road Fortson GA 31808 |
| Mailing Address |
P.o. Box 2787 Columbus GA 31902 |
| Practice Telephone | 7063236485 |
| Practice Fax Number | 7065962025 |
| Mailing Telephone | 7063236485 |
| Mailing Fax Number | 7065962025 |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2013-12-03 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085N0904X |
Radiology Specialization: Nuclear Radiology |
13317 | GA | Allopathic & Osteopathic Physicians |
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
13317 | GA | Allopathic & Osteopathic Physicians |
| N | 2085U0001X |
Radiology Specialization: Diagnostic Ultrasound |
13317 | GA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316430176 | Robert E Wallace | Case Manager/Care Coordinator | 283 Old Colliers Way, Weirton, WV 26062-4073 | 2018-06-07 |
| 1801337134 | Robert William Wallace II | Student in an Organized Health Care Education/Training Program | 204 N Silver Maple Dr, Slidell, LA 70458-5483 | 2017-03-20 |
| 1972947257 | Robert William Wallace | Registered Nurse | 40 Ridge Dr, West Hurley, NY 12491-5627 | 2013-04-17 |
| 1487991683 | Robert J Wallace | Acupuncturist | 1619 W Montrose, Chicago Holistic Medicine, Chicago, IL 60613 | 2013-01-08 |
| 1154582773 | Robert Lee Wallace | Counselor | 110 S Hancock St, Rockingham, NC 28379-3675 | 2008-06-17 |
| 1649484635 | Robert Jay Wallace | Obstetrics & Gynecology | 6250 Alfred Harrell Hwy, Bakersfield, CA 93308-9654 | 2007-05-09 |
| 1023132644 | Robert S Wallace | Chiropractor | 7 Centre Dr, Suite 10, Monroe, NJ 08831-1565 | 2007-03-19 |
| 1750443024 | Robert Wallace | Pharmacist | 12421 W Denton Ave, Litchfield Park, AZ 85340-3435 | 2006-12-14 |
| 1922113174 | Robert Vernon Wallace | Family Medicine | 400 Lee Blvd, Lehigh Acres, FL 33936-4923 | 2006-08-20 |
| 1134133200 | Robert Duncan Wallace | Psychiatry & Neurology | 2972 Devonshire Cir, Salt Lake City, UT 84108-2526 | 2006-07-27 |
| Street Address |
1130 GOAT ROCK ROAD |
| City | FORTSON |
| State | GA |
| Zip Code | 31808 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952599623 | Valley Healthcare System Inc | Clinic/Center | 94 Mccrary Road, Fortson, GA 31808 | 2007-10-09 |
| 1649885609 | Amber Love | Counselor | 10208 Whitesville Rd, Fortson, GA 31808-2623 | 2020-09-15 |
| 1104356443 | Laurie Wylie | Psychologist | 107 Twin Oaks Ct, Fortson, GA 31808-4479 | 2017-06-19 |
| 1477576635 | Richard E Wood Jr. | Family Medicine | 94 Mccrary Rd, Fortson, GA 31808-4558 | 2006-07-26 |
| 1063725745 | Shaunta' Shawan King | Dentist | 94 Mccrary Rd, Fortson, GA 31808-4558 | 2010-07-22 |
| 1093883878 | Lavon Thurman | Family Medicine | 94 Mccrary Rd, Fortson, GA 31808-4558 | 2006-12-01 |
| 1780174698 | William Henry Singleton | Physical Therapy Assistant | 398 Sputnik St, Fortson, GA 31808-5120 | 2018-05-16 |
| 1205448032 | Leona Ramsey Dorsey | Case Manager/Care Coordinator | 19 Shearwater Dr, Fortson, GA 31808-5316 | 2020-08-22 |
| 1497749626 | Judy R Barnett | Nurse Anesthetist, Certified Registered | 172 Almond Ridge Dr, Fortson, GA 31808-6823 | 2005-09-02 |
| 1487296034 | Archie Person IIi | Nurse Practitioner | 7933 Ivy Park Dr, Fortson, GA 31808-6870 | 2019-10-16 |
| Find all providers in zip 31808 | ||||
| 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 |
|---|---|---|---|---|
| 1326650136 | Tbi Diagnostic Centers of Georgia | Radiology | 4294 Memorial Dr Ste D, Decatur, GA 30032-1226 | 2020-08-21 |
| 1912464702 | Vickie Consuella71 Bush | Radiology | 3701 Bermuda Run Dr, Valdosta, GA 31605-1059 | 2019-02-27 |
| 1932685096 | T2 Imaging | Radiology | 1376 Church Street, Suite 100, Decatur, GA 30030 | 2018-07-12 |
| 1578061636 | Subspecialty Imaging, LLC | Radiology | 1495 Hickory Flat Hwy Ste 150, Canton, GA 30115-4229 | 2018-01-24 |
| 1205354693 | Zenith Radiology LLC | Radiology | 1059 Windermere Xing, Cumming, GA 30041-6104 | 2017-09-06 |
| 1558886341 | Synergy Radiology, LLC | Radiology | 1501 Milstead Road, Suite 140, Conyers, GA 30012 | 2017-08-14 |
| 1932624723 | M & B Imaging, PC | Radiology | 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 | 2017-08-14 |
| 1902346422 | Allegiance Imaging and Radiology LLC | Radiology | 900 Thornton Rd, Ste A, Lithia Springs, GA 30122-2641 | 2017-03-02 |
| 1518406743 | Flexogenix Georgia PC | Radiology | 4600 Roswell Rd Unit E210, Sandy Springs, GA 30342-3197 | 2017-02-21 |
| 1649727215 | Metro Imaging Cumming, LLC | Radiology | 4150 Deputy Bill Cantrell Memorial Road, Cumming, GA 30040 | 2016-09-01 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on DR. ROBERT G. WALLACE.
| 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.