Individual provider · NPI-1

Dr. Wallace Duncan, M.D.

Internal Medicine · Lithonia, GA

NPI number1821153529
StatusActive
Last updated in NPPESOct 17, 2011

Details

NPI
1821153529
Entity type
Individual (NPI-1)
Name
Dr. Wallace Duncan
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Dec 25, 2006
Last updated
Oct 17, 2011

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal Medicine041109GAYes

Practice location

5900 Hillandale Dr
Annex E
Lithonia, GA 30058-3802

Phone 770-987-8400 · Fax 770-987-8494

Mailing address

Po Box 924583
Norcross, GA 30010-4583

Phone 770-987-8400 · Fax 770-987-8494

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