Organization
WALLACE UROLOGY INC
Active
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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