Provider Demographics
NPI:1659548543
Name:WALLACE, DANA J (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:J
Last Name:WALLACE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:5901A PEACHTREE DUNWOODY RD
Mailing Address - Street 2:STE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5341
Mailing Address - Country:US
Mailing Address - Phone:678-892-2020
Mailing Address - Fax:678-538-1972
Practice Address - Street 1:5995 BARFIELD RD
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-4411
Practice Address - Country:US
Practice Address - Phone:404-256-1507
Practice Address - Fax:404-256-1981
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2021-03-08
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Provider Licenses
StateLicense IDTaxonomies
GA68018207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I188382Medicare PIN