Individual
MR. JAMES LEWIS WALLACE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
1901 BRUNSWICK AVE, SUITE 200, CHARLOTTE, NC 28207-2809
(704) 348-4488
(704) 348-4496
Mailing address
PO BOX 24905, WINSTON SALEM, NC 27114-4905
(336) 397-2165
(336) 397-2167
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7795261
—
NC
Enumeration date
01/26/2007
Last updated
07/23/2010
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