CHARLES R. WALLACE JR. (NPI# 1578621231) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578621231 |
| Entity Type | Individual |
| Full Name | CHARLES R. WALLACE JR. |
| Credential | MD |
| Practice Address |
1325 Eastmoreland Ave Suite 425 Memphis TN 38104-3519 |
| Practice Telephone | 9012723200 |
| Practice Fax Number | 9012783441 |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2008-06-24 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | MD0000015359 | TN | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902140932 | Charles L Wallace | Counselor | 2901 E. 20th Suite 104, Farmington, NM 87499 | 2012-11-15 |
| 1073643862 | Charles Wayne Wallace | Dentist | 502 N Coalter St, Staunton, VA 24401-3401 | 2007-03-07 |
| 1063584746 | Charles E Wallace | Dentist | 3221 Eastlake Ave E Ste 130, Seattle, WA 98102-7125 | 2006-11-15 |
| 1164422481 | Charles Alan Wallace | Surgery | 17110 Dallas Pkwy, Suite 100, Dallas, TX 75248-1167 | 2005-07-28 |
| 1144229600 | Charles Douglas Wallace | Orthopaedic Surgery | 3030 Childrens Way, Ste 410, San Diego, CA 92123-4232 | 2005-07-18 |
| 1780125203 | Charles Jerome Wallace | Counselor | 55 W 125th St Fl 11, New York, NY 10027-4516 | 2017-03-16 |
| 1851506463 | Charles William Wallace | Marriage & Family Therapist | 5738 Olde Wadsworth Blvd, Arvada, CO 80002-2535 | 2007-05-14 |
| 1881702736 | Charles T Wallace | Anesthesiology | 171 Ashley Ave, Charleston, SC 29425-0001 | 2006-08-29 |
| 1780652792 | Charles W Wallace | Family Medicine | 4455 Dressler Rd Nw, Canton, OH 44718-2785 | 2006-03-08 |
| Street Address |
1325 EASTMORELAND AVE SUITE 425 |
| City | MEMPHIS |
| State | TN |
| Zip Code | 38104-3519 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447255526 | Wendy L Dusenbury | Nurse Practitioner | 1325 Eastmoreland Ave, Suite 220, Memphis, TN 38104-3519 | 2005-06-16 |
| 1861935132 | Gastroenterology Center of The Midsouth PC | Non-Pharmacy Dispensing Site | 1325 Eastmoreland Ave, Suite 435, Memphis, TN 38104-3519 | 2016-11-18 |
| 1881149029 | Melody Jackson | Chiropractor | 1325 Eastmoreland Ave, Suite 425, Memphis, TN 38104-3519 | 2016-08-17 |
| 1356793327 | Meredith Alexis Rone | Nurse Practitioner | 1325 Eastmoreland Ave, 335, Memphis, TN 38104-3519 | 2016-07-01 |
| 1073915823 | Ut Methodist Physicians | General Acute Care Hospital | 1325 Eastmoreland Ave, Suite 460, Memphis, TN 38104-3519 | 2014-09-24 |
| 1740533595 | Mallory J Hamsher | Nurse Practitioner | 1325 Eastmoreland Ave, Suite 550, Memphis, TN 38104-3519 | 2012-10-17 |
| 1538418389 | Shekinah Jaquay Andrews | Nurse Practitioner | 1325 Eastmoreland Ave, Suite 220, Memphis, TN 38104-3519 | 2012-09-06 |
| 1750649646 | Rebecca L Reasons | Dietitian, Registered | 1325 Eastmoreland Ave, Suite 335, Memphis, TN 38104-3519 | 2012-04-27 |
| 1548550320 | Tracrw LLC H | Clinic/Center | 1325 Eastmoreland Ave, Memphis, TN 38104-3519 | 2011-04-13 |
| 1821397902 | Thomas M Middleton Jr. | Counselor | 1325 Eastmoreland Ave, Ste 500, Memphis, TN 38104-3519 | 2011-03-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900367 | Christy White | Recreation Therapist | 1030 Jefferson Ave (rt117), Memphis, TN 38104 | 2020-10-19 |
| 1821615873 | Altiana Carter | Optometrist | 650 New York St, Memphis, Tn 38104, Memphis, TN 38104 | 2020-06-25 |
| 1952898413 | Family To Family Adult Care Service | Chore Provider | 1331 Union Ave Suite 1028, Mempnis, TN 38104 | 2018-04-19 |
| 1326544800 | Kimberly Vestoria Mcclinton | Nurse Practitioner | 2200 Union Ave 1, Memphis, TN 38104 | 2018-04-03 |
| 1649799339 | Benjamin Duhart Jr. | Pharmacist | 1265 Union Avenue- Methodist University Hospital, Ground Floor Pharmacy Administration, Memphis, TN 38104 | 2017-09-13 |
| 1134644982 | Amy Michelle Wise | Nurse Practitioner | 1325 Eastmoreland Ave Ste 500, Memphis, TN 38104 | 2017-08-13 |
| 1316468572 | Jinger Cathey | Social Worker | 1330 Jefferson Ave, Memphis, TN 38104 | 2017-06-28 |
| 1336669183 | Charma May Kavuncu | Social Worker | 1407 Union Ave Ste 1100, Memphis, TN 38104 | 2017-06-22 |
| 1003345398 | Angelica J Dennis | Nurse Practitioner | 1265 Union, Memphis, TN 38104 | 2017-06-08 |
| 1609302546 | Cheryl Beene | Nurse Practitioner | 1211 Union Ave Ste 475, Memphis, TN 38104 | 2017-05-11 |
| Find all providers in zip 38104 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700101441 | Zachary Corr | Urology | 6029 Walnut Grove Rd Ste 300, Memphis, TN 38120 | 2010-04-06 |
| 1558522367 | Charles R. Wallace, Jr., Md | Urology | 1325 Eastmoreland Ave Ste 425, Memphis, TN 38104-7541 | 2008-06-24 |
| 1659389781 | Maurizio Buscarini | Urology | 910 Madison Ave Rm 409, Memphis, TN 38103-3403 | 2006-08-04 |
| 1710902440 | Leslie R Mcgowan | Urology | 6027 Walnut Grove Suite 319, The Urology Group PC, Memphis, TN 38120-2128 | 2006-07-13 |
| 1235164286 | David A Gubin | Urology | 6029 Walnut Grove Rd., Suite 300, Memphis, TN 38120 | 2006-07-11 |
| 1710945860 | Robert Alfred Donato | Urology | 995 S Yates Rd, Suite 1, Memphis, TN 38119-0882 | 2006-05-01 |
| 1316496664 | Wallace Urology Inc | Urology | 1325 Eastmoreland Ave Ste 425, Memphis, TN 38104-7541 | 2016-09-28 |
| 1902194897 | S K Ganguli Md PC | Urology | 6005 Park Ave, Suite 308, Memphis, TN 38119-5202 | 2011-07-13 |
| 1417272063 | Matthew Jude Mutter | Urology | 880 Madison Ave, Memphis, TN 38103-3409 | 2010-04-06 |
| 1306089206 | Baptist Memorial Medical Group Inc | Urology | 8970 Winchester Rd, Memphis, TN 38125-8231 | 2009-04-08 |
| Find all providers in MEMPHIS | ||||
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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.