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Organization
WALLACE URGENT CARE LLC
Active
Organization
WALLACE URGENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KAMRAN GOUDARZI M.D. (OWNER)
(910) 552-1580
Entity
Organization
Contact information
Practice address
112 MEDICAL VILLAGE DR, UNIT F, WALLACE, NC 28466-9999
(910) 552-1580
(910) 665-1780
Mailing address
112 MEDICAL VILLAGE DR, UNIT F, WALLACE, NC 28466-9999
(910) 552-1580
(910) 665-1780
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01736
NCBCBS PROVIDER NUMBER
NC
05
—
7901736
—
NC
Enumeration date
03/17/2006
Last updated
06/24/2025
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