Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Grant Wallace

Individual provider Registered Nurse · NPI 1336006642

Grant Wallace is a Registered Nurse in Atlanta, Georgia. Practices as a sole proprietor. Licensed in Georgia.

Licensed in
GA
In the registry since
2026

Practice location Address checks out

1520 Clifton Rd NE Ste 244
Atlanta, GA 30322-4201
Phone: (404) 727-7980
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Registered Nurse (primary) Taxonomy 163W00000X · Licence RN319027 (GA)

Record details

NPI number1336006642
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJanuary 7, 2026
Last updated in NPPESJanuary 7, 2026
Certification dateJanuary 7, 2026
Mailing address72 Walthall St Se Unit B, Atlanta, GA 30316-1328

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