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William Wallace
NPI 1437184017 · on the registry since 2006
Practice
- Address
- 1421 N State St # St.1
Ste. 504
Jackson, MS 39202 - Phone
- (601) 969-9050
- Fax
- (601) 354-2443
Registry record
- Primary taxonomy
- 173000000X
173000000X
- Licence states on file
- MS
From the registry's licence fields, which are often incomplete.
- Sex
- Male
- Record last updated
- 2007-07-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Mississippi