Individual
JOHN WALLACE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1705 GARDNER DR, WILMINGTON, NC 28405-8873
(910) 343-5300
(910) 254-1352
Mailing address
1705 GARDNER DR, WILMINGTON, NC 28405-8873
(910) 343-5300
(910) 254-1352
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
98-01546
NC
2084P0800X
Psychiatry Physician
9801546
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5920117
—
NC
Enumeration date
04/28/2008
Last updated
04/27/2015
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