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John Gray Wallace, MD
Family Medicine Physician in Kosciusko, Mississippi
NPI 1831486596

John Gray Wallace is a Family Medicine Physician based in Jackson, MS. John Gray Wallace practices in Kosciusko, MS and has the professional credentials of MD. The NPI Number for John Gray Wallace is 1831486596 and holds a License No. 22522 (Mississippi).

The current practice location address for John Gray Wallace is 332 Highway 12 W, Kosciusko, MS and can be reached out via phone at 662-289-1800 and via fax at 662-289-2486.

Location: 332 Highway 12 W, Kosciusko, MS, 39225-3996
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1831486596
Provider Name
John Gray Wallace
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
332 Highway 12 W, Kosciusko, MS, 39225-3996
Phone Number
662-289-1800
Fax Number
662-289-2486
Provider Enumeration Date
07/01/2011
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
07830815 05 MS
institution
Provider Business Practice Location Address Details
Address
332 Highway 12 W
City
Kosciusko
State
Mississippi
Zip
39090-3209
Phone Number
662-289-1800
Fax Number
662-289-2486
person
Provider Business Mailing Address Details
Address
332 Highway 12 W
City
Kosciusko
State
Mississippi
Zip
39090-3209
Phone Number
662-289-1800
Fax Number
662-289-2486
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
22522 (Mississippi)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
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