Tina Wallace

Primary specialty

Home Infusion AgencyTaxonomy code 251F00000X

Practice address

2408 Carson Rd Unit 1
Birmingham, AL 35215-3102

Phone

(205) 757-0249

NPI assigned

Apr 26, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619395200000",
    "number": "1164004420",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 SUNHILL RD NW APT H",
            "city": "CENTER POINT",
            "state": "AL",
            "postal_code": "352153043",
            "telephone_number": "205-757-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2408 CARSON RD UNIT 1",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352153102",
            "telephone_number": "205-757-0249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TINA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-04-26",
        "last_updated": "2021-04-26",
        "certification_date": "2021-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Grace Wallace
• Savannah Wallace
• Stephenie B Wallace, M.D.
• Suzanne Watson Wallace, MD
• Terrance Terrell Wallace, D.P.T
• Emily Waller
• Leah Bryant Waller, LCSW
• Raquel Simone Waller
• Tiffany Betts Waller, CRNP
• Susan C Walley, M.D.

• Home Infusion Agency in Birmingham, AL
• Providers in Birmingham, AL by specialty
• Home Infusion Agency in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.