Individual
MELANIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
845 S MADISON ST, TUPELO, MS 38801-4905
(662) 377-5930
(662) 377-5085
Mailing address
845 S MADISON ST, TUPELO, MS 38801-4905
(662) 377-5930
(662) 377-5085
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
11799
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00114470
—
MS
Enumeration date
04/26/2006
Last updated
07/14/2010
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