CATHERINE WALLACE MD NPI 1154946606

NPI Information

NPI: 1154946606
Provider Name: CATHERINE WALLACE, MD
Classification: General Practice - 208D00000X
Entity Type: Individual
PECOS Registration: Yes
Address: 243 MERCHANTS DR
DALLAS, GA
ZIP 30132
Phone: (770) 230-9967

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NPI Details

Catherine Wallace, MD is a general practice in Dallas, GA with 5 years of experience. The provider is a physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee Catherine Wallace, MD NPI is 1154946606. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

Education
Medical School: MEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduation Year:2020

The provider's business location address is:

243 MERCHANTS DR
DALLAS, GA
ZIP 30132-700
Phone: (770) 230-9967
Fax: (770) 445-5860

The NPI 1154946606 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/10/2020 and was last updated on 5/2/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	208D00000X	General Practice		94669	GEORGIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	8101560001	OTHER	GEORGIA	DME MAC JURISDICTION C

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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