DR. LOGAN LAUDERDALE WALLACE MD
NPI 1811567100
Student in an Organized Health Care Education/Training Program in Johnson City, TN
About Dr. Logan Lauderdale Wallace Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. LOGAN LAUDERDALE WALLACE MD (NPI 1811567100) is an individual student in an organized health care education/training program in Johnson City, Tennessee and active in the NPI registry since June 2021.
NPPES Registry Identity
Specialties & Licenses
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
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 Logan Wallace's NPI number?
The NPI number for Logan Wallace is 1811567100. It was assigned to this individual provider in the NPPES registry on June 29, 2021.
Where is Logan Wallace located?
Logan Wallace practices at 400 N State Of Franklin Rd, Johnson City, TN 37604. The listed phone number is (423) 431-6111.
What is Logan Wallace's specialty?
The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.
When was this NPI record last updated?
The NPPES record for Logan Wallace was last updated on June 22, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months 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.
# Dr. Logan Lauderdale Wallace, MD · NPI 1811567100
Student in an Organized Health Care Education/Training Program provider in Johnson City, Tennessee. Individual provider, active in the CMS NPPES registry since June 29, 2021.
## Identity
- **NPI:** 1811567100 (Entity type: Individual)
- **Enumerated:** June 29, 2021
- **Primary specialty:** Student in an Organized Health Care Education/Training Program · taxonomy 390200000X
- **Sole proprietor:** No
## Practice location
- **Address:** 400 N STATE OF FRANKLIN RD, Johnson City, TN 37604-6035
- **Phone:** (423) 431-6111
## Record status
- **NPPES last updated:** June 22, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1811567100) · Data from the CMS NPPES public registry.