JOHN M. WALLACE (NPI# 1174537708) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174537708 |
| Entity Type | Individual |
| Full Name | JOHN M. WALLACE |
| Credential | M.D. |
| Practice Address |
1203 Jefferson St Laurel MS 39440-4354 |
| Practice Telephone | 6016492863 |
| Practice Fax Number | 6016499479 |
| Mailing Telephone | 6016492863 |
| Mailing Fax Number | 6016499479 |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-07-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RP1001X |
Internal Medicine Specialization: Pulmonary Disease |
08491 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00011285 | 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 |
1203 JEFFERSON ST |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-4354 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497702302 | David L Harrison | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2006-05-27 |
| 1134762610 | South Central Regional Medical Center | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2019-10-28 |
| 1235698846 | Mary Morgan | Nurse Practitioner | 1203 Jefferson St, Laurel, MS 39440-4354 | 2019-03-14 |
| 1518443134 | Rebecca Suzanne Scarbrough | Nurse Practitioner | 1203 Jefferson St, Laurel, MS 39440 | 2018-07-17 |
| 1093232506 | South Central Clinics, Inc | Psychiatry & Neurology | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1457878969 | South Central Clinics, Inc | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1376060830 | South Central Clinics, Inc | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1346767852 | South Central Clinics, Inc | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1821515388 | South Central Clinics, Inc | Clinic/Center | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1811414378 | South Central Clinics, Inc | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 207RP1001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Pulmonary Disease |
| An internist who treats diseases of the lungs and airways. The pulmonologist diagnoses and treats cancer, pneumonia, pleurisy, asthma, occupational and environmental diseases, bronchitis, sleep disorders, emphysema and other complex disorders of the lungs. |
| 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 |
|---|---|---|---|---|
| 1811414378 | South Central Clinics, Inc | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2017-08-25 |
| 1093955239 | Hesyra Medical Associates LLC | Internal Medicine | 7300 Van Dusen Rd, Laurel Regional Hospital, Laurel, MD 20707-9463 | 2009-02-28 |
| 1265456818 | Kimberly Dobbs | Internal Medicine | 1203 Jefferson St, Laurel, MS 39440-4354 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134393473 | Yadana Kyaw | Internal Medicine | 401 Southcrest Cir Ste 212, Southaven, MS 38671 | 2008-04-17 |
| 1447450622 | Jennifer R Gardner | Internal Medicine | 2301 South Lamar, Suite 100, Oxford, MS 38655 | 2007-07-25 |
| 1689870479 | George H Kotti IIi | Internal Medicine | 301 Fisher St Ste 1f-130, Keesler Afb, MS 39534-2508 | 2007-06-27 |
| 1730306192 | J. L. Miles,do Sleep Lab | Internal Medicine | 2705 Hwy 90, Ocean Springs, MS 39564 | 2007-04-19 |
| 1205050408 | J. L. Miles, Do Sleep Lab | Internal Medicine | 779 Jackson St, Biloxi, MS 39530-4231 | 2007-04-12 |
| 1770706863 | Felix Morris M.d., LLC | Internal Medicine | 1777 Curtis Drive, Iuka, MS 38852 | 2007-04-10 |
| 1508914102 | Oxford Lung Physicians, P.a. | Internal Medicine | 2301 S Lamar Blvd Ste 100, 2301 S Lamar Blvd Ste 100, Oxford, MS 38655-5373 | 2007-01-08 |
| 1760564660 | William Thomas Williams Jr. | Internal Medicine | 1200 N State St Ste 500, Jackson, MS 39202-2027 | 2006-10-19 |
| 1447357652 | Gulf Coast Lung and Sleep Medicine Institute, LLC | Internal Medicine | 16120 Landon Rd, Suite B, Gulfport, MS 39503-6119 | 2006-09-20 |
| 1053414326 | Jeffrey Neal Evans | Internal Medicine | 2301 South Lamar Blvd Suite 100, 2301 South Lamar Blvd Suite 100, Oxford, MS 38655-0768 | 2006-09-05 |
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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.