John Gray Wallace, M.D.

NPI #1831486596 in Kosciusko, Mississippi

Provider Information

NPI Number: 1831486596
Entity Type: Individual
Name: John Gray Wallace, M.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Family Medicine
Credential: M.D.
Enumeration Date: Jul 1, 2011
Last Updated: Sep 22, 2014

Practice Location

Address: 332 HIGHWAY 12 W
City: Kosciusko
State: Mississippi
ZIP Code: 39090-3209
Phone: (662) 289-1800

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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