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Organization

WALLACE UROLOGY INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHARLES RUSSELL WALLACE JR. M.D. (MEDICAL DOCTOR)
(901) 272-3200
Entity
Organization

Contact information

Practice address
1325 EASTMORELAND AVE STE 425, MEMPHIS, TN 38104-7541
(901) 272-3200
(901) 278-3441
Mailing address
1325 EASTMORELAND AVE STE 425, MEMPHIS, TN 38104-7541
(901) 272-3200
(901) 278-3441

Taxonomy

Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
015359
TN

Other

Enumeration date
09/28/2016
Last updated
09/28/2016
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