DR. PERRY WALLACE (NPI# 1922044502) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922044502 |
| Entity Type | Individual |
| Full Name | DR. PERRY WALLACE |
| Credential | MD |
| Practice Address |
2121 5th St Suite 202 Meridian MS 39301-5108 |
| Mailing Address |
4156 A Pl Meridian MS 39301-1037 |
| Practice Telephone | 6012863410 |
| Practice Fax Number | 6012863425 |
| Mailing Telephone | 6624020608 |
| Mailing Fax Number | 6012863425 |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2011-11-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207P00000X | Emergency Medicine | 10491 | MS | Allopathic & Osteopathic Physicians |
| N | 207P00000X | Emergency Medicine | 29610 | TN | Allopathic & Osteopathic Physicians |
| Y | 207R00000X | Internal Medicine | 13895 | AL | Allopathic & Osteopathic Physicians |
| N | 207R00000X | Internal Medicine | 10491 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | 3331790 | 05 | |
| GA | 417498226A | 05 |
| Street Address |
2121 5TH ST SUITE 202 |
| City | MERIDIAN |
| State | MS |
| Zip Code | 39301-5108 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407460439 | Kayla Lee Monsour | Pharmacist | 1415 24th Avenue, Meridian, MS 39301 | 2020-09-08 |
| 1306478359 | K&r Optical Solutions Corporation | Eyewear Supplier (Equipment, not the service) | 3126 8th St., Suite A, Meridian, MS 39301 | 2020-02-07 |
| 1912537317 | Courtney M Hollie | Counselor | 1054 Ms-19, Meridian, MS 39301 | 2020-01-24 |
| 1932636495 | Rcg Mississippi, Inc. | Clinic/Center | 1300 38th Ave E, Meridian, MS 39301 | 2017-05-16 |
| 1811428915 | Tierria Mcglothin | Nurse Practitioner | 1054 Highway 19 S, Meridian, MS 39301 | 2017-03-21 |
| 1154869303 | Lindsay Nemanich | Physical Therapist | 3716 Ms-39, Meridian, MS 39301 | 2017-02-08 |
| 1700323599 | Wal-mart Stores East Lp | Pharmacy | 3310-a Highway 39 North, Meridian, MS 39301 | 2017-01-31 |
| 1972977460 | Southeast Pharmacy LLC | Pharmacy | 2402 Long Creek Road, Meridian, MS 39301 | 2015-11-20 |
| 1235508342 | East Mississippi Oral & Facial Surgery, LLC | Clinic/Center | 1212 24th Avenue, Meridian, MS 39301 | 2015-09-18 |
| 1831580778 | Clarkdale Pharmacy and Gifts LLC | Pharmacy | 6935c Hwy 145, Meridian, MS 39301 | 2015-02-13 |
| Find all providers in zip 39301 | ||||
| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003278730 | Tyler T Birch | Internal Medicine | 520 S Eagle Rd Ste 3102, Meridian, ID 83642-6352 | 2016-03-22 |
| 1932459997 | Thomas L Lucky | Internal Medicine | 1216 Constitution Ave, Meridian, MS 39301-4003 | 2012-09-17 |
| 1720342777 | Spencer Miller | Internal Medicine | 3525 E Louise Drive Suite 400, Meridian, ID 83642-6303 | 2012-06-25 |
| 1891086021 | Byron Elliott Brown | Internal Medicine | 7019 N Penncross Way, Meridian, ID 83646-5185 | 2011-04-21 |
| 1306086541 | Kristi Warren Durgin | Internal Medicine | 1800 45th Ct, Meridian, MS 39305-2733 | 2009-02-28 |
| 1912147240 | Edward G. Scott Jr. | Internal Medicine | 4714 11th Pl, Meridian, MS 39305-2768 | 2009-02-26 |
| 1285851337 | Frederick M Costello | Internal Medicine | 520 S. Eagle Rd, Ste 3104, Meridian, ID 83642 | 2007-04-19 |
| 1396833398 | Olugboyega O Ransome-kuti | Internal Medicine | 2701 Davis Street, Meridian, MS 39301-5708 | 2006-10-11 |
| 1518077437 | James H Gallafent | Internal Medicine | 520 S. Eagle Road, Suite #3102, Meridian, ID 83642 | 2006-08-30 |
| 1497797302 | Ann C Agnew | Internal Medicine | 3080 E Gentry Way Ste 210, Meridian, ID 83642-3013 | 2006-06-12 |
| Find all providers in MERIDIAN | ||||
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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.