Individual
DR. LACIE VICTORIA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1400 HOSPITAL DR, MT PLEASANT, SC 29464-3255
(843) 884-1341
(843) 884-1345
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(888) 472-0043
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
86050
SC
207Q00000X
Family Medicine Physician
LL86050
SC
Other
Enumeration date
06/02/2021
Last updated
09/11/2024
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