DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: MRS. MINNIE WALLACE

MEDICARE: MRS. MINNIE WALLACE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1972445161
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MINNIE WALLACE
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 200
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5028
Country : US
Telephone Number : 866-610-0580
Fax Number : 866-611-1558
Provider Business Practice Location Address
First Line : 4920 ROSWELL RD STE 1
Second Line :
City : ATLANTA
State : GA
Zip : 30342-2684
Country : US
Telephone Number : 470-258-4050
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2026
Last Update Date : 04/07/2026

Similar Medicare Providers

1750224978 — OLIVIA GRACE ALEXANDER
Practice Location Address:
4920 ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-250-4050
Practice Fax:
1194668293 — NOAH TREMBLAY KISTENBERG
Practice Location Address:
4920 ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-258-4050
Practice Fax:
1033608617 — REGINA NASTRI BCBA
Practice Location Address:
4920 ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-725-8405
Practice Fax: 470-408-2364
1851931281 — HEAVENLY WILKINSON MA, BCBA
Practice Location Address:
4920 NE ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-258-4050
Practice Fax:
1003423153 — ROCHELLE WYCHE
Practice Location Address:
4920 ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-258-4163
Practice Fax:
1487252904 — AFEAGA IZIEGBE HAMLETT MS, RBT
Practice Location Address:
4920 ROSWELL RD STE 1
ATLANTA, GA
30342-2684
Practice Phone: 470-258-4163
Practice Fax: 470-208-2364

Directions to “ MRS. MINNIE WALLACE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.