Michael C Wallace, MD
Family Medicine in Memphis, TN. Individual provider (NPI-1).
NPI number1932192556
StatusActive
Last updated in NPPESOct 25, 2016
Details
- NPI
- 1932192556
- Entity type
- Individual (NPI-1)
- Name
- Michael C Wallace
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 30, 2005
- Last updated
- Oct 25, 2016
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | MD36875 | TN | Yes |
Practice location
7685 Winchester RdMemphis, TN 38125-2202
Phone 901-752-6963 · Fax 901-751-5540
Mailing address
Po Box 405827Atlanta, GA 30384-5800
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