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General NPI Number Information
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NPI Number | 1154341782
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Entity Type | Individual
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Provider Name | RHONDA L WALLACE MD
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Gender | Female
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 09/03/2025
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Provider Practice Location Address
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Address Line | 11 ARLEY WAY STE 201
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City | BLUFFTON
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State | SC
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Zip | 29910-4883
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Country | US
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Telephone | 843-706-8690
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Fax |
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Provider Business Mailing Address
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Address Line | 11 ARLEY WAY STE 201
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City | BLUFFTON
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State | SC
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Zip | 29910-4883
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Country | US
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Telephone | 843-706-8690
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0451697
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PAC0350
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | LL40878
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2025007208
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License Number State | MO
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 40878
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License Number State | SC
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