TRACEY C WALLACE (NPI# 1265475206) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1265475206 |
| Entity Type | Individual |
| Full Name | TRACEY C WALLACE |
| Credential | M.D. |
| Practice Address |
3525 Piedmont Rd Ne Bldg 7-601 Atlanta GA 30305-1578 |
| Mailing Address |
1121 Johnson Ferry Rd Suite 100 Marietta GA 30068-5425 |
| Practice Telephone | 7705091025 |
| Mailing Telephone | 7705091025 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2016-10-03 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 042483 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 00777697A | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144483033 | Tracey Lynn Wallace | Audiologist-Hearing Aid Fitter | 14101 Molly Berry Rd, Brandywine, MD 20613-2306 | 2008-07-09 |
| 1053748038 | Tracey Wallace | Counselor | 122 Wolf Tail Ct Sw, Atlanta, GA 30349-6547 | 2013-10-04 |
| 1770638165 | Tracey Wallace | Occupational Therapist | 5415 N Bloomfield Rd, Canandaigua, NY 14424-7964 | 2007-01-24 |
| Street Address |
3525 PIEDMONT RD NE BLDG 7-601 |
| City | ATLANTA |
| State | GA |
| Zip Code | 30305-1578 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447258975 | Michael Warren Bain | Psychiatry & Neurology | 3525 Piedmont Rd Ne, Bldg 6, Suite 210, Atlanta, GA 30305-1578 | 2005-07-08 |
| 1225582562 | Destination Greatness-georgia, LLC | Counselor | 3525 Piedmont Rd Ne, Building 7, Suite 300, Atlanta, GA 30305-1578 | 2016-08-03 |
| 1487907473 | Nancy Sineath Rank | Counselor | 3525 Piedmont Rd Ne, Building 8, Suite 102, Atlanta, GA 30305-1578 | 2012-10-16 |
| 1003168469 | Eleanor Mcmichael Stewart | Counselor | 3525 Piedmont Rd Ne, Piedmont Center, Bldg. 8, Suite 102, Atlanta, GA 30305-1578 | 2012-10-10 |
| 1952618605 | Brian D Katz | Physician Assistant | 3525 Piedmont Rd Ne, Bldg 7-601, Atlanta, GA 30305-1578 | 2010-09-01 |
| 1497077044 | Buckhead Mohs Surgical Center LLC | Clinic/Center | 3525 Piedmont Rd Ne, Building 6, Suite 220, Atlanta, GA 30305-1578 | 2010-02-24 |
| 1073713277 | Atlanta Skin Cancer Specialists, P.C. | Clinic/Center | 3525 Piedmont Rd Ne, Building 6, Suite 220, Atlanta, GA 30305-1578 | 2007-07-25 |
| 1124137351 | Katarina Gabrielle Lequeux-nalovic | Dermatology | 3525 Piedmont Rd Ne, Building 6, Suite 220, Atlanta, GA 30305-1578 | 2006-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659981322 | Gerald E Roettger | Physical Therapist | 2955 Peachtree Road Nw, Suite A1, Atlanta, GA 30305 | 2020-08-06 |
| 1689202681 | Pt Hills Place Terraces LLC | Assisted Living Facility | 229 Peachtree Hills Place, Atlanta, GA 30305 | 2020-03-27 |
| 1043704299 | Alyssa Elrod Utz | Pharmacist | 3495 Piedmont Road, First Floor, Suite 110, Atlanta, GA 30305 | 2018-06-20 |
| 1508373689 | Kathryn Gohde | Counselor | 3525 Piedmont Rd Nw, Bldg 7 Suite 408, Atlanta, GA 30305 | 2018-01-10 |
| 1386195154 | Ryan Gabriel Wilkins | Physical Therapist | 550 Pharr Rd Ne Ste 550, Atlanta, GA 30305 | 2016-10-17 |
| 1821440587 | Monica Martinez Dicristina | Counselor | 3525 Piedmont Road, Building 7, Suite 408, Atlanta, GA 30305 | 2016-07-06 |
| 1164879532 | Brittany Nicole Albritton | Physical Therapist | 3169 Maple Drive Ne, Atlanta, GA 30305 | 2016-05-16 |
| 1588039275 | Alaina Blevins | Physician Assistant | 240 Pharr Rd Ne, Atlanta, GA 30305 | 2015-12-07 |
| 1558750141 | A2h2 | Clinic/Center | 2909 Peachtree Rd; Nw;, Atlanta, GA 30305 | 2015-01-20 |
| 1144619016 | We Up Home Health Services LLC | Clinic/Center | 2909 Peachtree Rd; Nw, Atlanta, GA 30305 | 2015-01-15 |
| Find all providers in zip 30305 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841800836 | Ascend Medical Georgia PC | Family Medicine | One Alliance Center, 3500 Lenox Road Suite 1500, Atlanta, GA 30326 | 2020-08-04 |
| 1912521782 | Eagles Landing Family Practice, LLC | Family Medicine | 3333 Riverwood Pkwy Se Ste 250, Atlanta, GA 30339-3304 | 2020-06-08 |
| 1487297164 | Deavmed L.l.c | Family Medicine | 3915 Cascade Rd Sw Ste T-90, Atlanta, GA 30331-8660 | 2019-10-24 |
| 1598319287 | Vibrant Family Medicine, P.C. | Family Medicine | 6667 Vernon Woods Dr Ste A19, Atlanta, GA 30328-3215 | 2019-07-30 |
| 1649739020 | Accumedic Diagnostic Management LLC | Family Medicine | 373 W Lake Ave Nw, Atlanta, GA 30318-8123 | 2019-03-15 |
| 1679037758 | Harrigan Medical Consulting Services, Inc | Family Medicine | 3280 Howell Mill Rd Nw Ste 207, Atlanta, GA 30327-4100 | 2019-01-23 |
| 1184197337 | Todd Ware Davis | Family Medicine | 942 Fern Ave Se, Atlanta, GA 30315-1813 | 2019-01-09 |
| 1881165207 | Le Reve Medical Clinic PC | Family Medicine | 1827 Powers Ferryy Rd Se Bldg 7, Suite 150, Atlanta, GA 30339 | 2018-12-11 |
| 1265902092 | Gregory Stephen Wallace | Family Medicine | 1042 Mason Woods Dr Ne, Atlanta, GA 30329-3802 | 2018-12-05 |
| 1124596069 | Longevity Medical Center, PC | Family Medicine | 4646 N Shallowford Rd Ste 300, Atlanta, GA 30338-6308 | 2018-11-08 |
| Find all providers in ATLANTA | ||||
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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.