James Lewis Wallace Jr., CPO

Primary specialty

OrthotistTaxonomy code 222Z00000X

Practice address

1901 Brunswick Ave
Suite 200
Charlotte, NC 28207-2809

Phone

(704) 348-4488

Fax

(704) 348-4496

NPI assigned

Jan 26, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1279843200000",
    "number": "1396891933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 24905",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271144905",
            "telephone_number": "336-397-2165",
            "fax_number": "336-397-2167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 BRUNSWICK AVE",
            "address_2": "SUITE 200",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282072809",
            "telephone_number": "704-348-4488",
            "fax_number": "704-348-4496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JAMES",
        "middle_name": "LEWIS",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2010-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Z00000X",
            "taxonomy_group": "",
            "desc": "Orthotist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7795261",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chloe Wallace
• Courtni Wallace
• Cynthia C Wallace, MA, LCMHCS, NCC
• Dawn Spruill Wallace, DDS
• Devesdra Wallace
• James William Wallace, M.D.
• Jill Marie Wallace, N.P.
• Joyce W Wallace, LCSW, LISW-CP
• Kayla Wallace
• Khaira-Nisaa Hicks Wallace

• Orthotist in Charlotte, NC
• Providers in Charlotte, NC by specialty
• Orthotist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2010; 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.