Individual
DR. AMBER ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1686 SKYLYN DR, SUITE 101, SPARTANBURG, SC 29307
(864) 560-3456
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
01063765A
IN
207V00000X
Obstetrics & Gynecology Physician
2012-01577
NC
207V00000X
Obstetrics & Gynecology Physician
Primary
MD35398
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NC1735
—
SC
01
—
P01330093
RAILROAD MEDICARE
SC
01
—
SC07923365
MEDICARE PIN
SC
01
—
SC07926162
MEDICARE PIN
SC
Enumeration date
05/22/2007
Last updated
05/16/2023
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