Individual
DR. JAMES HOWARD WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 22ND AVE FL 3, MERIDIAN, MS 39301
(601) 693-1055
(601) 482-5312
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(901) 227-8693
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
T-2618
MS
208800000X
Urology Physician
Primary
25034
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08128741
—
MS
05
—
487562499A
—
GA
05
—
G13318
—
SC
01
—
T-2618
STATE MEDICAL BOARD
MS
Enumeration date
09/25/2006
Last updated
11/20/2024
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