DR. WILLIAM J WALLACE (NPI# 1275539603) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275539603 |
| Entity Type | Individual |
| Full Name | DR. WILLIAM J WALLACE |
| Credential | D.O. |
| Practice Address |
5 Sheridan Sq Kingsport TN 37660 |
| Mailing Address |
5 Sheridan Sq Kingsport TN 37660-7390 |
| Practice Telephone | 4232468155 |
| Practice Fax Number | 2462468658 |
| Mailing Telephone | 4232468155 |
| Mailing Fax Number | 2462468658 |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2018-06-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YS0123X |
Otolaryngology Specialization: Facial Plastic Surgery |
01428 | TN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 006500391 | 05 | |
| KY | 64071962 | 05 | |
| TN | 3306857 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518500834 | William J Wallace Jr. | Chiropractor | 22415 Market St Apt 1406, Cornelius, NC 28031-3028 | 2019-10-18 |
| 1851740609 | William Robert Wallace | Internal Medicine | 20828 W Deer Ridge Dr, Warrenton, MO 63383-6548 | 2016-06-11 |
| 1093143745 | William Dean Wallace | Pathology | 747 W 4170 S, Murray, UT 84123-1364 | 2013-10-16 |
| 1255765194 | William Wallace | Counselor | 318 S Oak, California, MO 65018 | 2013-08-28 |
| 1598028474 | William Todd Wallace | Physical Therapist | 8225 Coyote Trl, Texarkana, TX 75503-9657 | 2012-06-16 |
| 1184842627 | William Arthur Wallace Jr. | Surgery | 1679 Eagle Harbor Pkwy, Suite C, Fleming Island, FL 32003-4815 | 2007-04-22 |
| 1013087121 | William R Wallace | Chiropractor | 139 Morristown Rd, Bernardsville, NJ 07924-2606 | 2006-11-08 |
| 1508880493 | William C Wallace | Physical Therapist | 1113 N Castle Heights Ave, Suite D, Lebanon, TN 37087-5640 | 2006-07-26 |
| 1437184017 | William H. Wallace | Legal Medicine | 1421 N State St # St.1, Ste. 504, Jackson, MS 39202-1658 | 2006-07-11 |
| 1225087562 | William E Wallace | Surgery | 2000 Ben Merritt Dr, Suite B, Decatur, TX 76234-3848 | 2006-05-06 |
| Street Address |
5 SHERIDAN SQ |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316943731 | Carl W. Slocum | Otolaryngology | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2005-06-21 |
| 1538334446 | Toby N Johnson | Audiologist | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2008-04-23 |
| 1053586958 | Gina B Roberson | Audiologist | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2008-04-23 |
| 1447469952 | Jennifer Lynn Greiner | Otolaryngology | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2007-05-21 |
| 1619973047 | David R Osterhus | Otolaryngology | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2005-06-21 |
| 1417953845 | Meadowview Ent Specialists | Specialist | 5 Sheridan Sq, Kingsport, TN 37660-7390 | 2005-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 207YS0123X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Facial Plastic Surgery |
| An otolaryngologist who specializes in facial plastic surgery. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A General Certificate was, but is no longer issued by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902166341 | Lucas M Bryant | Otolaryngology | 660 S Mount Juliet Rd Ste 120, Mt Juliet, TN 37122-3968 | 2012-05-19 |
| 1881773778 | Mark Allen Clymer | Otolaryngology | 1800 Mallory Ln, Ste A3, Brentwood, TN 37027 | 2006-11-03 |
| 1811999006 | James Aachen-winans | Otolaryngology | 415 Sewell Dr, Sparta, TN 38583-1223 | 2005-06-01 |
| 1265847040 | Mitchel Sauvageau | Otolaryngology | 4230 Harding Pike Ste 400, Nashville, TN 37205-4900 | 2014-06-30 |
| 1396701413 | Phillip R Langsdon | Otolaryngology | 1910 Nonconnah Blvd, Suite 120, Memphis, TN 38132-2113 | 2006-04-26 |
Please comment or provide details below to improve the information on DR. WILLIAM J WALLACE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.