Charles R. Wallace, Jr., MD

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

CHARLES R. WALLACE, JR., MD

Practice address

1325 Eastmoreland Ave Ste 425
Memphis, TN 38104-7541

Phone

(901) 272-3200

Fax

(901) 278-3441

NPI assigned

Jun 24, 2008

Organization subpart

No

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

Authorized official

Name

Mrs. Ann Marie Wallace

Title

Office Manager

Phone

(901) 272-3200

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1214265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214265600000",
    "number": "1558522367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE STE 425",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047541",
            "telephone_number": "901-272-3200",
            "fax_number": "901-278-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 EASTMORELAND AVE STE 425",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381047541",
            "telephone_number": "901-272-3200",
            "fax_number": "901-278-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES R. WALLACE, JR., MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-24",
        "last_updated": "2008-06-24",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "ANN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "901-272-3200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0040441",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Todd Chappell, M.D.
• Rachael Ann Chapple, FNP-C, ENP-C
• Carolyn Clare Charbonnet, MD
• Charles R Burnett, Jr.
• Charles R. Andrews
• Denisa Hancock Charles, PHARMD
• Lanny Charles, LCSW
• Charlotte Deflumere, MD,PC
• Karen Hintz Charlton, CFNP
• Hedy Chase, RPH

• Urology Physician in Memphis, TN
• Providers in Memphis, TN by specialty
• Urology Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.