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

Jacqueline Wallace

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1154168482

Jacqueline Wallace is a Student in an Organized Health Care Education/Training Program in Atlanta, Georgia. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

1364 Clifton Rd NE
Atlanta, GA 30322-6504
Phone: (404) 712-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1154168482
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedJuly 12, 2024
Last updated in NPPESApril 3, 2025
Certification dateApril 3, 2025
Mailing address1745 Derry Ave Sw, Atlanta, GA 30310-1503

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