William Miles Wallace

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

0101031586 Issued in VA

Practice address

1933 Thomson Dr
Lynchburg, VA 24501-1008

Phone

(434) 947-3928

Fax

(434) 947-3982

NPI assigned

Jul 21, 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Centra Health Inc

  • General Acute Care Hospital
  • Lynchburg, VA
  • NPI 1770693939
  NPD (past)

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

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770504342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1933 THOMSON DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011008",
            "telephone_number": "434-947-3928",
            "fax_number": "434-947-3982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1933 THOMSON DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245011008",
            "telephone_number": "434-947-3928",
            "fax_number": "434-947-3982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "WILLIAM",
        "middle_name": "MILES",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "VA",
            "license": "0101031586",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnathan Walkine
• Joseph Charles Preston Wall, LPC
• Deaven McGuire Wallace, MA, LPC
• Donald McQuire Wallace, DDS
• Kojo Wallace, MD
• Brenda Sue Waller, M.D.
• Sandra Waller, CERTIFIED HAIR LOSS
• John Wallman, PT
• Mary Wallman, PT
• Matthew Robert Wallman, PA-C

• Neurology Physician in Lynchburg, VA
• Providers in Lynchburg, VA by specialty
• Neurology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.