MEDICARE: TRACEY C WALLACE M.D.

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
1	207Q00000X	Family Medicine Physician	042483	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265475206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY C WALLACE M.D.

Provider Business Mailing Address
First Line	:	1121 JOHNSON FERRY RD
Second Line	:	SUITE 100
City	:	MARIETTA
State	:	GA
Zip	:	30068-5425
Country	:	US
Telephone Number	:	770-509-1025
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 PIEDMONT RD NE
Second Line	:	BLDG 7-601
City	:	ATLANTA
State	:	GA
Zip	:	30305-1578
Country	:	US
Telephone Number	:	770-509-1025
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	02/26/2021

Similar Medicare Providers

1447258975 — DR. MICHAEL WARREN BAIN MD
Practice Location Address:

3525 PIEDMONT RD NE , BLDG 6, SUITE 210
ATLANTA, GA
30305-1578

Practice Phone: 404-261-8291
Practice Fax: 404-261-5107

1497077044 — BUCKHEAD MOHS SURGICAL CENTER LLC
Practice Location Address:

3525 PIEDMONT RD NE , BUILDING 6, SUITE 220
ATLANTA, GA
30305-1578

Practice Phone: 404-446-3200
Practice Fax: 404-446-3201

1952618605 — BRIAN D KATZ PAC
Practice Location Address:

3525 PIEDMONT RD NE , BLDG 7-601
ATLANTA, GA
30305-1578

Practice Phone: 404-842-5400
Practice Fax: 404-848-8638

1003168469 — ELEANOR MCMICHAEL STEWART M.ED.
Practice Location Address:

3525 PIEDMONT RD NE , PIEDMONT CENTER, BLDG. 8, SUITE 102
ATLANTA, GA
30305-1578

Practice Phone: 404-550-4210
Practice Fax:

1487907473 — DR. NANCY SINEATH RANK PHD
Practice Location Address:

3525 PIEDMONT RD NE , BUILDING 8, SUITE 102
ATLANTA, GA
30305-1578

Practice Phone: 404-848-9948
Practice Fax: 404-848-9974

1962098053 — ROBERT MONN
Practice Location Address:

3525 PIEDMONT RD NE STE 620
ATLANTA, GA
30305-1578

Practice Phone: 678-575-3570
Practice Fax:

Directions to “ TRACEY C WALLACE M.D.” 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.