1. Home
  2. Directory
  3. Georgia
  4. Fayetteville
  5. Psychiatry Neurology
  6. NPI Profile

MR. WALLACE MAXWELL GREEN PAC
NPI 1306979059
Psychiatry & Neurology - Neurology in Fayetteville, GA

Active since March 13, 2007
1275 HIGHWAY 54 W, STE.105, FAYETTEVILLE, GA 30214(770) 719-2965(770) 719-2963 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Wallace Maxwell Green Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. WALLACE MAXWELL GREEN PAC (NPI 1306979059) is an individual neurology provider in Fayetteville, Georgia, licensed in Georgia (001827) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1306979059
Entity TypeIndividualMale
Primary Taxonomy2084N0400X
Provider Legal NameMR. WALLACE MAXWELL GREENCredential: PAC
Location Address1275 HIGHWAY 54 W, STE.105Fayetteville, GA 30214-4549
Mailing Address1275 Highway 54 W, Ste.105Fayetteville, GA 30214-4549 · (770) 719-2965 · Fax (770) 719-2963
Phone(770) 719-2965
Fax(770) 719-2963
Sole ProprietorNo
Enumeration DateMarch 13, 2007
Last NPPES UpdateJuly 8, 2007
✔ NPI 1306979059 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychiatry & Neurology · NeurologyAllopathic & Osteopathic Physicians
Taxonomy Code2084N0400X
License✔ Licensed in GA · 001827
Definition
A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures.
1275 HIGHWAY 54 W, Fayetteville, GA 30214
Open in Google Maps ↗

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

J. RENA OWSLEY-BROWN DMD
Dentist (General Practice)
1275 HIGHWAY 54 W, SUITE 204
FAYETTEVILLE, GA 30214
Fayette County (770) 461-5500
MS. SHANNON WILLIAMS ALEXANDER OTR L
Occupational Therapist
1275 HIGHWAY 54 W, STE 200
FAYETTEVILLE, GA 30214
Fayette County (770) 460-8609
MARTHA A SCHUH, MD
Specialist
1275 HIGHWAY 54 W, SUITE 201
FAYETTEVILLE, GA 30214
Fayette County (770) 461-3776
MR. JOHN W SIMS N.P.
Nurse Practitioner
1275 HIGHWAY 54 W, SUITE 200
FAYETTEVILLE, GA 30214
Fayette County (770) 461-3776
AARON H HONEYCUTT PT, DPT
Physical Therapist
1275 HIGHWAY 54 W, SUITE 200
FAYETTEVILLE, GA 30214
Fayette County (770) 460-8609
P E T IMAGING OF FAYETTE LLC
Radiology (Diagnostic Radiology)
1275 HIGHWAY 54 W, STE 102
FAYETTEVILLE, GA 30214
Fayette County (770) 719-3754
MARTHA A SCHUH M.D.
Specialist
1275 HIGHWAY 54 W, SUITE 201
FAYETTEVILLE, GA 30214
Fayette County (770) 461-3776
J. RENA OWSLEY-BROWN
Dentist (General Practice)
1275 HIGHWAY 54 W, SUITE 204
FAYETTEVILLE, GA 30214
Fayette County (770) 461-5500

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wallace Green's NPI number?

The NPI number for Wallace Green is 1306979059. It was assigned to this individual provider in the NPPES registry on March 13, 2007.

Where is Wallace Green located?

Wallace Green practices at 1275 Highway 54 W Ste.105, Fayetteville, GA 30214. The listed phone number is (770) 719-2965.

What is Wallace Green's specialty?

The primary specialty registered for this NPI is Psychiatry & Neurology, specializing in Neurology, with taxonomy code 2084N0400X.

When was this NPI record last updated?

The NPPES record for Wallace Green was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.