Individual
KARA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4650 WHITESBURG DR SW, SUITE 204, HUNTSVILLE, AL 35802-1670
(256) 533-5211
(256) 533-5084
Mailing address
4650 WHITESBURG DR SW, SUITE 204, HUNTSVILLE, AL 35802-1670
(256) 533-5211
(256) 533-5084
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
23260
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
510G700152
MC PTAN
—
01
—
51510722
BCBS OF ALABAMA PIN
AL
Enumeration date
07/25/2007
Last updated
03/24/2016
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