Lester B. Wallace Jr., MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

21891 Issued in NC

Practice address

1718 E 4TH St
Suite 201
Charlotte, NC 28204-3261

Phone

(704) 384-0560

Fax

(704) 384-0561

NPI assigned

Jul 28, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The C. W. Williams Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Charlotte, NC
  • NPI 1447417670
  NPD (past)

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361232000000",
    "number": "1295749000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "704-384-0560",
            "fax_number": "704-384-0561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1718 E 4TH ST",
            "address_2": "SUITE 201",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282043261",
            "telephone_number": "704-384-0560",
            "fax_number": "704-384-0561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LESTER",
        "middle_name": "B.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2013-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NC",
            "license": "21891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "N21891",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8985506",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joyce W Wallace, LCSW, LISW-CP
• Kayla Wallace
• Khaira-Nisaa Hicks Wallace
• Kristen Nicole Wallace
• Lacey L Wallace
• Monica M. Wallace, LCSW
• Noah Wallace
• Portia Dionne Wallace
• Robert Bowman Wallace, DPT
• Robert T Wallace, C.PED.

• Obstetrics & Gynecology Physician in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Obstetrics & Gynecology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2013; 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.