Individual
LAURIE MEAGAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1268 NEXTON PKWY STE 104, SUMMERVILLE, SC 29486-2167
(843) 212-8080
(843) 402-2681
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2075
NE
207Q00000X
Family Medicine Physician
Primary
93547
SC
Other
Enumeration date
04/19/2018
Last updated
05/07/2025
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