| Dr Logan Lauderdale Wallace, MD | |
|
300 East Hospital Road, Fort Gordon, GA 30905-5650 | |
| (707) 786-5811 | |
| Not Available |
| Full Name | Dr Logan Lauderdale Wallace |
|---|---|
| Gender | Male |
| Speciality | General Practice |
| Location | 300 East Hospital Road, Fort Gordon, Georgia |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811567100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 2022-02887 (North Carolina) | Primary |
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Logan Lauderdale Wallace, MD 1722 Tagatay C, Fort Bragg, NC 28307 Ph: () - | Dr Logan Lauderdale Wallace, MD 300 East Hospital Road, Fort Gordon, GA 30905-5650 Ph: (707) 786-5811 |
Nicholas Carroll Destefano, MD General Practice Medicare: Medicare Enrolled Practice Location: 300 E Hospital Rd, Fort Gordon, GA 30905 Phone: 706-383-5299 | |
Phillip Joseph Markey, MD General Practice Medicare: Medicare Enrolled Practice Location: 300 E Hospital Rd, Fort Gordon, GA 30905 Phone: 706-787-9399 | |
Dr. Darrell Faubert Barker, M.D. General Practice Medicare: Medicare Enrolled Practice Location: 300 East Hospital Road, Fort Gordon, GA 30905 Phone: 706-836-9829 |