Wallace, Candice E
Wallace, Candice E is an individual health care provider with primary practice located at 1000 Medical Center Blvd , Lawrenceville GA 30045-7694. She recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medical Services, which is considered as her primary health care specialty. Wallace, Candice E can be contacted via phone (678) 442-3317.Contact Information
Primary practice address
1000 Medical Center Blvd
Lawrenceville GA 30045-7694
Phone: (678) 442-3317
Fax: (678) 442-4416
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Emergency Medical Services | 207PE0004X | 030918 | Georgia |
Profile Details
| NPI number | 1881730687 |
|---|---|
| LBN Legal business name | Wallace, Candice E |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 29th, 2007 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1881730687 | NPPES |
| Georgia | MEDICAID | 00405468D |
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