Wallace, William J

Wallace, William J is an individual health care provider with primary practice located at 5 Sheridan Sq , Kingsport TN 37660. He recently has only one registered license in Allopathic & Osteopathic Physicians / Facial Plastic Surgery, which is considered as his primary health care specialty. Wallace, William J can be contacted via phone (423) 246-8155.

Contact Information

Primary practice address
5 Sheridan Sq Kingsport TN 37660
Phone: (423) 246-8155
Fax: (246) 246-8658
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Facial Plastic Surgery 207YS0123X 01428 Tennessee

Profile Details

NPI number 1275539603
LBN Legal business name Wallace, William J
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 21st, 2005
Last updated Jun 4th, 2018 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275539603 NPPES
Tennessee MEDICAID 3306857
Tennessee MEDICAID 64071962
Tennessee MEDICAID 006500391

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