Individual provider · Type 1 NPI

William Jacob Wallace, PA

Surgical Physician Assistant · Cookeville, TN

NPI number 1992183412 Active

Practice location

105 S Willow Ave
Cookeville, TN 38501-4667

Call (931) 372-7716 Map

Fax (931) 372-0087

Mailing address

203 N Cedar Ave
Cookeville, TN 38501-2498

Other practice locations

  • 150 Sam Walton Dr, #600, Sparta, TN 38583-8815 · (931) 739-4000
  • 203 N Cedar Ave, Cookeville, TN 38501 · (931) 528-1992

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant 363AM0700X2743 (TN)
Surgical Physician Assistant Primary 363AS0400XPA2743 (TN)

Surgical Physician Assistant: Definition to come...

23 other providers at this address

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About NPI 1992183412

William Jacob Wallace, PA's National Provider Identifier is 1992183412, issued on May 16, 2015. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Cookeville, TN. The record was last updated on Aug 27, 2020.