Provider Demographics
NPI:1689671323
Name:WEEKS, WALLACE R (MD)
Entity Type:Individual
Prefix:DR
First Name:WALLACE
Middle Name:R
Last Name:WEEKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1107 MEMORIAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-226-3139
Mailing Address - Fax:706-278-6606
Practice Address - Street 1:1107 MEMORIAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-226-3139
Practice Address - Fax:706-278-6606
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2013-12-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA25066207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000278924CMedicaid
GA000278924CMedicaid
GA08BDNCNMedicare ID - Type Unspecified