Individual
DR. ERICA RENEE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
4023 GUILFORD COLLEGE RD, GREENSBORO, NC 27407-8052
(336) 890-2040
(336) 890-2099
Mailing address
300 E WENDOVER AVE, GREENSBORO, NC 27401-1229
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2012-00866
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5920661
—
NC
01
—
NC7155A
MEDICARE PTAN
NC
Enumeration date
05/15/2009
Last updated
09/04/2025
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