John Gray Wallace, M.D. Valid NPI
Individual provider · Family Medicine Physician · Kosciusko, MS
- NPI
- 1831486596
- Type
- Individual (Type 1)
- Primary specialty
- Family Medicine Physician (Family Medicine)
- Specialty group
- Allopathic & Osteopathic Physicians
- Taxonomy code
- 207Q00000X
- License number
- 22522 (MS)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2011-07-01
- Last updated
- 2014-09-22
Practice location
332 Highway 12 W
Kosciusko, MS 39090-3209
(662) 289-1800