BRIAN CHARLES WALLACE (NPI# 1114378759) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114378759 |
| Entity Type | Individual |
| Full Name | BRIAN CHARLES WALLACE |
| Practice Address |
125 W Catawba Ave Mount Holly NC 28120-1601 |
| Practice Telephone | 7048273014 |
| Mailing Telephone | 7048273014 |
| Enumeration Date | 2016-06-24 |
| Last Update Date | 2016-07-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 0010-06531 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093866121 | Brian Wallace | Dentist | 781 S Lake Dr, Suite 1, Prestonsburg, KY 41653-1340 | 2007-01-16 |
| 1801864350 | Brian Wallace | Internal Medicine | 9005 Kilbride Rd, Baltimore, MD 21236-2017 | 2006-03-10 |
| 1831198811 | Brian David Wallace | Radiology | 1100 Brookhaven Rd, Franklin, KY 42134-2746 | 2005-07-20 |
| 1861939845 | Brian Wallace | Counselor | 7907 Ostrow St Ste F, San Diego, CA 92111-3635 | 2017-01-27 |
| 1154677359 | Brian Venson Wallace | Physical Therapist | 711 Avignon Dr, Ridgeland, MS 39157-5120 | 2012-07-25 |
| 1598083495 | Brian William Wallace | Chiropractor | 139 Morristown Rd, Bernardsville, NJ 07924-2633 | 2010-05-17 |
| 1790017028 | Brian Edward Wallace | Anesthesiology | 400 E Pioneer Ave, Suite 101, Puyallup, WA 98372-3255 | 2010-02-11 |
| 1518118462 | Brian Robert Wallace | Orthopaedic Surgery | 1250 Pine Ridge Rd, Suite 203, Naples, FL 34108-8913 | 2008-10-08 |
| 1518124627 | Brian Scott Wallace | Emergency Medicine | 1200 S Cedar Crest Blvd, Allentown, PA 18103-6202 | 2008-05-18 |
| 1427248350 | Brian J Wallace | Physician Assistant | 325 Princeton Ave, Princeton, NJ 08540-1617 | 2007-07-26 |
| Street Address |
125 W CATAWBA AVE |
| City | MOUNT HOLLY |
| State | NC |
| Zip Code | 28120-1601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558353896 | Gregory Lee Glass | Family Medicine | 125 W Catawba Ave, Mount Holly, NC 28120-1601 | 2005-08-22 |
| 1649418872 | Sara Elaine Phillips | Physician Assistant | 125 W Catawba Ave, Mount Holly, NC 28120-1601 | 2009-01-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851775027 | Wesley Marsh | Dentist | 176 Palomino Trl, Mt Holly, NC 28120 | 2015-07-16 |
| 1407094642 | Kelly Lee Coney Pacious | Physical Therapist | 328 Whippoorwill Lane, Mount Holly, NC 28120 | 2009-01-26 |
| 1427183979 | Touched By Angels Home Healthcare, Inc. | Home Health | 16 Oak Grove St, Mt Holly, NC 28120 | 2007-02-23 |
| 1417052119 | Andrew Rogers Oblinger | Dentist | 247 W Catawba Ave, Mt Holly, NC 28120 | 2006-09-14 |
| 1437648334 | Moose Pharmacy of Mt Holly LLC | Durable Medical Equipment & Medical Supplies | 125 W Central Ave, Mount Holly, NC 28120 | 2018-05-07 |
| 1104898634 | Michael Alson Smith | Family Medicine | 305 W Catawba Ave, Mount Holly, NC 28120 | 2006-02-07 |
| 1972642049 | Woodlawn Haven, Inc | Assisted Living Facility | 301 Craig St, Mount Holly, NC 28120-1265 | 2007-02-06 |
| 1306455126 | A Place 4 Me, LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 5305 Clearwater Lake Rd, Mount Holly, NC 28120-1445 | 2020-07-28 |
| 1487946380 | Monica K Rendon | Specialist | 320 Langhorne Dr, Mt Holly, NC 28120-1452 | 2011-05-10 |
| 1033750674 | Amanda Marie Antczak | Counselor | 129 Maggie Dr, Mount Holly, NC 28120-1486 | 2019-10-04 |
| Find all providers in zip 28120 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669916557 | Eric Soult | Physician Assistant | 108 Ridgeway St, Mount Holly, NJ 08060-1440 | 2016-12-12 |
| 1588650394 | John Martin Bradshaw | Physician Assistant | 112 Woodlawn Rd, Mount Holly, NC 28120-1775 | 2005-09-27 |
| 1922587401 | Caralynn Marie Arena | Physician Assistant | 175 Madison Ave, Mount Holly, NJ 08060-2099 | 2018-08-07 |
| 1982139739 | Katelyn Marie Dowling | Physician Assistant | 175 Madison Ave, Mount Holly, NJ 08060-2038 | 2017-04-28 |
| 1811167703 | Rose Williams | Physician Assistant | 215 S Main St, Mount Holly, NC 28120-1620 | 2008-03-06 |
| 1215977269 | Gary Greenberg | Physician Assistant | 175 Madison Ave, Mount Holly, NJ 08060-2038 | 2006-06-07 |
| 1740237056 | Carolyn Doris Nixon | Physician Assistant | 175 Madison Ave, Mount Holly, NJ 08060-2038 | 2006-05-30 |
| 1447207477 | South Jersey Emergency Physicians | Physician Assistant | 175 Madison Ave, Mount Holly, NJ 08060-2038 | 2006-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215538459 | Sarah Jane Lamanna | Physician Assistant | 3012 Bristol Creek Dr, Morrisville, NC 27560-7811 | 2020-11-04 |
| 1043819741 | Brad Russell Tolan | Physician Assistant | 211 Pinegate Cir Apt 12, Chapel Hill, NC 27514-2221 | 2020-10-22 |
| 1265030654 | Vanessa Vinson | Physician Assistant | 284 Lower Edgewood Rd, Candler, NC 28715-9285 | 2020-10-16 |
| 1649878810 | Courtney Michelle Watlington | Physician Assistant | 360 N Bennett St, Southern Pines, NC 28387-4813 | 2020-10-11 |
| 1669079034 | Christine Meyer | Physician Assistant | 2523 Creek Ridge Ln, Chapel Hill, NC 27514-7454 | 2020-10-07 |
| 1407453319 | Khyan Waddell | Physician Assistant | 127 Sneed Rd, Enfield, NC 27823-9589 | 2020-10-04 |
| 1053918979 | Amjad Ali | Physician Assistant | 730 Montlieu Ave, High Point, NC 27260-4000 | 2020-10-04 |
| 1104433382 | Aditi Bhattacharjee Sundaresan | Physician Assistant | 131 Mallard Ct, Chapel Hill, NC 27517-9104 | 2020-09-30 |
| 1689281933 | Kathryn Tarulli | Physician Assistant | 600 W Main St Apt 624, Durham, NC 27701-5005 | 2020-09-29 |
| 1205443991 | Kelsey Mendez | Physician Assistant | 105 Basket Oak Dr, Bunnlevel, NC 28323-9141 | 2020-09-26 |
| Find all providers with the same taxonomy | ||||
| City | MOUNT HOLLY |
| Zip Code | 28120 |
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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.