Individual
DR. WILLIAM J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
146 E HOSPITAL DR STE 200, WEST COLUMBIA, SC 29169-4800
(803) 936-7530
(803) 936-7532
Mailing address
PO BOX 6069, WEST COLUMBIA, SC 29171-6069
(803) 936-7530
(803) 936-7532
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
39895
SC
207YS0123X
Facial Plastic Surgery Physician
01428
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006500391
—
VA
05
—
3306857
—
TN
05
—
64071962
—
KY
Enumeration date
06/21/2005
Last updated
03/18/2026
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