Active NPI
David Gene Wallace, D.PH.
- Pharmacist
- Dover, TN
National Provider Identifier
1972844843
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 4339
- Practice address
- 1307 Donelson Pkwy
Dover, TN 37058-3724 - Phone
- (931) 232-0123
- Fax
- (931) 232-1185
- NPI assigned
- Mar 1, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 4339 | TN | Primary |
Addresses
Primary practice location
1307 Donelson Pkwy
Dover, TN 37058-3724
Mailing address
1307 Donelson Pkwy
Dover, TN 37058-3724
Phone (931) 232-0123
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4339 | TN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1362096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1362096000000",
"number": "1972844843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1307 DONELSON PKWY",
"city": "DOVER",
"state": "TN",
"postal_code": "370583724",
"telephone_number": "931-232-0123",
"fax_number": "931-232-1185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1307 DONELSON PKWY",
"city": "DOVER",
"state": "TN",
"postal_code": "370583724",
"telephone_number": "931-232-0123",
"fax_number": "931-232-1185"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "DAVID",
"middle_name": "GENE",
"name_prefix": "Dr.",
"credential": "D.PH.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-03-01",
"last_updated": "2013-03-01",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "TN",
"license": "4339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dover, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 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.