WALLACE FORD MARTIN


Address: 631 Professional Drive, Suite 300, Lawrenceville, GA 30046-3371
Phone: 7709629977

WALLACE FORD MARTIN (NPI# 1487651386) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1487651386
Entity Type Individual
Full Name WALLACE FORD MARTIN
Credential MD
Practice Address 631 Professional Drive
Suite 300
Lawrenceville
GA 30046-3371
Practice Telephone 7709629977
Practice Fax Number 7703399804
Mailing Telephone 7709629977
Mailing Fax Number 7703399804
Enumeration Date 2005-07-07
Last Update Date 2010-09-01
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 208600000X Surgery 026153 GA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
GA 00301914A 05
GA MEDICARE GROUP NUMBER GRP1797 01

Office Location

Street Address 631 PROFESSIONAL DRIVE
SUITE 300
City LAWRENCEVILLE
State GA
Zip Code 30046-3371

Providers in the same location

NPI Name Taxonomy Address Enumeration
1003041104 Barbara O'callaghan Registered Nurse 631 Professional Drive, 450, Lawrenceville, GA 30046-7651 2009-05-19
1861627028 Theresa Lynn Catlin Registered Nurse 631 Professional Drive, Suite 450, Lawrenceville, GA 30046-7651 2009-05-18
1902003841 Charles B Moomey Jr Md Surgery 631 Professional Drive, Suite 300, Lawrenceville, GA 30046-3371 2007-07-02
1639226178 John A. Chandler Physician Assistant 631 Professional Drive, Suite 200, Lawrenceville, GA 30046-3367 2007-01-05
1710049036 Gwinnett Consultants In Cardiology Specialist 631 Professional Drive, Ste 360, Lawrenceville, GA 30046-0000 2006-12-14
1508926759 Suburban Hematology Oncology Associates, PC Internal Medicine 631 Professional Drive, Suite 450, Lawrenceville, GA 30046-7651 2006-12-11
1659460244 Christopher T Hagenstad Internal Medicine 631 Professional Drive, Ste 210, Lawrenceville, GA 30046 2006-10-12
1821187436 Anthony M Landis Internal Medicine 631 Professional Drive, Suite 450, Lawrenceville, GA 30046-7651 2006-10-12
1073602751 Alexander Saker Jr. Internal Medicine 631 Professional Drive, Suite 450, Lawrenceville, GA 30046 2006-10-12
1114969052 Satvir Singh Internal Medicine 631 Professional Drive, Suite 450, Lawrenceville, GA 30046-7651 2006-06-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1063023174 Alpha & Omega Hearing Centers Hearing Instrument Specialist Alpha & Omega Hearing Centers, 250 Langley Drive, Suite 1106, Lawrenceville, GA 30046 2020-08-12
1285259846 Mesun Health Services, Inc Clinical Nurse Specialist 88 Johnson Rd Building # 1-b, Lawrenceville, GA 30046 2020-06-10
1215550264 Mesun Health Services, Inc Skilled Nursing Facility 88 Johnson Rd. Building #2, Lawrenceville, GA 30046 2020-05-26
1306499785 Bryan Acosta Chiropractor 471 Scenic Hwy South, Lawrenceville, GA 30046 2019-07-24
1205308616 Belle Lumiere Cosmetics LLC Dermatology 753 Old Norcross Road, Lawrenceville, GA 30046 2018-12-24
1548730179 Alexis Nicole Robinson Nurse Anesthetist, Certified Registered 1000 Medical Center Boulevard, Lawrenceville, GA 30046 2018-11-27
1679060388 Christopher Puckett Student in an Organized Health Care Education/Training Program 665 Duluth Hwy Suite 501, Lawrenceville, GA 30046 2018-04-18
1457851255 Advanced Urology Institute of Georgia Urology 501 Crown Point Way, Lawrenceville, GA 30046 2018-02-19
1013447044 Pharmacy Investments of Lawrenceville, LLC Pharmacy 738 Old Norcross Road, Ste A, Lawrenceville, GA 30046 2017-06-13
1225577000 Priority Housecalls LLC Clinic/Center 225 Scenic Hwy, Ste 200, Lawrenceville, GA 30046 2017-02-14
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Taxonomy Information

Taxonomy Code 208600000X
Grouping Allopathic & Osteopathic Physicians
Classification Surgery

Taxonomy Definition

A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery.
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 Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification
- Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1306239017 Georgia Hill Surgery 631 Professional Dr Ste 470, Lawrenceville, GA 30046-3370 2015-03-05
1992865463 F.enrique Alvarez Md Surgery 123 Franklin Corner Rd Ste 204, Lawrenceville, NJ 08648-2526 2006-12-12
1497855779 Kevin Lee Jensen Surgery 743 Old Norcross Rd, Lawrenceville, GA 30046-4317 2006-09-25
1174583470 Suraj Jose Menachery Surgery 631 Professional Dr Ste 300, Lawrenceville, GA 30046-3371 2006-03-23
1679136824 Northside Gwinnett Surgical Associates, LLC Surgery 631 Professional Dr Ste 300, Lawrenceville, GA 30046-3371 2019-04-15
1972918050 Georgia Breast Surgery PC Surgery 631 Professional Dr, Suite 240, Lawrenceville, GA 30046-3367 2014-06-26
1205105731 Jessica Reynolds Surgery 631 Professional Dr Ste 300, Lawrenceville, GA 30046-3371 2011-12-29
1396049383 Gwinnett Surgical Associates, LLP Surgery 631 Professional Dr, Suite 300, Lawrenceville, GA 30046-3367 2011-01-05
1154653590 Dr. Stephen Quill, Md, PC Surgery 771 Old Norcross Rd, Suite 300, Lawrenceville, GA 30046-4386 2010-02-10
1134370711 Luttrell L Toussaint Surgery 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 2008-10-01
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Competitor

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City LAWRENCEVILLE
Zip Code 30046

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Dataset Information

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.

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