IndividualActive
Wallace Green, PAC
NPI 1306979059 · Neurology Physician · Fayetteville, GA
Provider details
- NPI number
- 1306979059
- Entity type
- Individual
- Primary specialty
- Neurology PhysicianAllopathic & Osteopathic Physicians
- Credential
- PAC
- Sex
- Male
- Sole proprietor
- No
- License
- 001827 (GA)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
Detailed profile(89/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
1275 Highway 54 W
Ste.105
Fayetteville, GA 30214-4549
Phone: (770) 719-2965
Fax: (770) 719-2963
Street-level locationGet directions
Mailing address
1275 Highway 54 W
Fayetteville, GA 30214-4549
Registry dates
- Enumerated
- 2007-03-13
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.