JOHN GRAY WALLACE (NPI# 1831486596) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831486596 |
| Entity Type | Individual |
| Full Name | JOHN GRAY WALLACE |
| Credential | M.D. |
| Practice Address |
332 Highway 12 W Kosciusko MS 39090-3209 |
| Mailing Address |
Po Box 23996 Jackson MS 39225-3996 |
| Practice Telephone | 6622891800 |
| Practice Fax Number | 6622892486 |
| Mailing Telephone | 6012066100 |
| Mailing Fax Number | 6012066052 |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2014-09-22 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 22522 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 07830815 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023508868 | John E Wallace | Physical Therapist | 1060 Nimitzview Dr Ste 205, Cincinnati, OH 45230-4351 | 2018-05-17 |
| 1679900161 | John D Wallace | Counselor | 1455 Nw 53rd St Apt 222, Miami, FL 33142 | 2013-09-30 |
| 1437590973 | John Burton Wallace V | Social Worker | 141 S 5th St Ofc East, Brooklyn, NY 11211 | 2013-07-12 |
| 1346517307 | John Widtsoe Wallace | Specialist | 1091 Southport Dr, Medina, OH 44256-3019 | 2011-11-18 |
| 1225292634 | John Wallace | Anesthesiology | 3420 S Mercy Rd Ste 200, Gilbert, AZ 85297-0423 | 2008-07-15 |
| 1629241070 | John Dean Wallace Jr. | Dentist | 9913 Mission Gorge Rd Unit 1, Santee, CA 92071-3843 | 2008-04-08 |
| 1275663916 | John Robert Wallace | Physical Therapist | 103 W Woodhill Dr, Suite A, Nags Head, NC 27959 | 2007-03-06 |
| 1346379161 | John G Wallace | Psychiatry & Neurology | 17515 N Park Pl N, Shoreline, WA 98133-4803 | 2007-03-05 |
| 1841359775 | John Thomas Wallace | Chiropractor | 3314 Us Highway 431, Albertville, AL 35950 | 2006-12-06 |
| 1316038839 | John Kline Wallace | Dentist | 2501 Princess Anne St, Fredericksburg, VA 22401-3333 | 2006-09-28 |
| Street Address |
332 HIGHWAY 12 W |
| City | KOSCIUSKO |
| State | MS |
| Zip Code | 39090-3209 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902868961 | Benjamin Thomas Carter | Emergency Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2006-04-05 |
| 1427656230 | Kimberly Michele Myer | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2020-10-14 |
| 1710401575 | Robert Kirtis Greenlee | Nurse Practitioner | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2017-08-02 |
| 1922458348 | Hannah Tingle | Occupational Therapist | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2016-06-16 |
| 1649653775 | Hannah Cooper | Nurse Practitioner | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2015-07-07 |
| 1083994701 | Wanda Grace Mccullough | Social Worker | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2011-08-25 |
| 1942595202 | Samuel Joseph Holdiness | Internal Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2011-06-15 |
| 1609178094 | Krista Bain Blaylock | Nurse Practitioner | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2010-11-17 |
| 1144534900 | Newsouth Neurospine, LLC. | Anesthesiology | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2010-08-03 |
| 1700016763 | Sridevi Alla | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2009-07-23 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508371675 | Caroline Boydstun Fair | Pharmacist | 109 Northside Center, Kosciusko, MS 39090 | 2017-12-11 |
| 1275069643 | Sharhonda Wingo | Speech-Language Pathologist | 2447 Attala Road 2203, Kosciusko, MS 39090 | 2017-05-04 |
| 1013392034 | Leap of Faith LLC | Respite Care | 115 North Wells Street, Suite A, Kosciusko, MS 39090 | 2015-07-21 |
| 1730566027 | Bmc - Attala, LLC | General Acute Care Hospital | 220 Hwy. 12 West, Kosciusko, MS 39090 | 2015-05-06 |
| 1528402484 | Warner Martin Myers I | Student in an Organized Health Care Education/Training Program | 912 Hwy 12 East, Kosciusko, MS 39090 | 2013-04-23 |
| 1891022547 | Medical Foundation of Central Mississippi | Internal Medicine | 329 Highway 12 West, Koscuisko, MS 39090 | 2009-11-17 |
| 1255512448 | Cheryl L Bayne | Adult Companion | 509 Hillview Dr, Kosciusko, MS 39090 | 2007-11-16 |
| 1760673982 | Gary A Cochran | Technician/Technologist | 118 West North St, Kosciusko, MS 39090 | 2007-08-05 |
| 1639396393 | Stephen C Hammack | Family Medicine | 332 Highway 12 West, Kosciusko, MS 39090 | 2007-04-20 |
| 1740329689 | Brenda Nail | Nurse Practitioner | 999 Martin Luther King Drive, Kosciusko, MS 39090 | 2007-02-06 |
| Find all providers in zip 39090 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639396393 | Stephen C Hammack | Family Medicine | 332 Highway 12 West, Kosciusko, MS 39090 | 2007-04-20 |
| 1073585824 | Robert Gregory Browning | Family Medicine | 530 Veterans Memorial Dr, Kosciusko, MS 39090-3858 | 2006-02-06 |
| 1427656230 | Kimberly Michele Myer | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2020-10-14 |
| 1023481595 | Bmc - Attala, LLC | Family Medicine | 220 Highway 12 W, Kosciusko, MS 39090-3208 | 2015-11-05 |
| 1376846469 | Trace Medical Clinic, Pllc | Family Medicine | 530 Veterans Memorial Dr, Kosciusko, MS 39090-3858 | 2010-12-10 |
| 1700016763 | Sridevi Alla | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2009-07-23 |
| 1033383815 | Trace Medical Clinic | Family Medicine | 530 Veterans Memorial Dr, Kosciusko, MS 39090-3858 | 2008-04-14 |
| 1154478410 | Edward E Bryant | Family Medicine | 530 Veterans Memorial Dr, Kosciusko, MS 39090-3858 | 2007-01-05 |
| 1295815462 | James J Withers | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2006-10-16 |
| 1073576070 | Michael G Holman | Family Medicine | 332 Highway 12 W, Kosciusko, MS 39090-3209 | 2006-04-10 |
| Find all providers in KOSCIUSKO | ||||
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| 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.