Wallace, Logan Lauderdale

Wallace, Logan Lauderdale is an individual health care provider with primary practice located at 300 East Hospital Road , Fort Gordon GA 30905-5650. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / General Practice, Student, Health Care / Student in an Organized Health Care Education/Training Program. Allopathic & Osteopathic Physicians / General Practice is his primary health care specialty. Wallace, Logan Lauderdale can be contacted via phone (707) 786-5811.

Contact Information

Primary practice address
300 East Hospital Road Fort Gordon GA 30905-5650
Phone: (707) 786-5811
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / General Practice 208D00000X 2022-02887 North Carolina
Student, Health Care / Student in an Organized Health Care Education/Training Program 390200000X

Profile Details

NPI number 1811567100
LBN Legal business name Wallace, Logan Lauderdale
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 29th, 2021
Last updated Aug 14th, 2023 - about 3 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.

Request for update

Popular Providers