Individual provider · Type 1 NPI
Robert G. Wallace, MD
Diagnostic Radiology Physician · Fortson, GA
NPI number
1780015610
Active
Practice location
1130 Goat Rock Road
Fortson, GA 31808
Fax (706) 596-2025
Mailing address
P.o. Box 2787
Columbus, GA 31902
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nuclear Radiology Physician | 2085N0904X | 13317 (GA) |
| Diagnostic Radiology Physician Primary | 2085R0202X | 13317 (GA) |
| Diagnostic Ultrasound Physician | 2085U0001X | 13317 (GA) |
Diagnostic Radiology Physician: A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.
About NPI 1780015610
Robert G. Wallace, MD's National Provider Identifier is 1780015610, issued on Dec 3, 2013. The primary taxonomy on file is Diagnostic Radiology Physician (2085R0202X), and the practice location is in Fortson, GA. The record was last updated on Dec 3, 2013.