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General NPI Number Information
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NPI Number | 1659635472
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Entity Type | Individual
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Provider Name | MESHIA KERRY-ANN WALLACE MD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2012
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 2412 VILLAGE PROFESSIONAL DR S
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City | OPELIKA
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State | AL
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Zip | 36801
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Country | US
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Telephone | 334-528-6670
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Fax | 334-528-6671
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Provider Business Mailing Address
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Address Line | 2412 VILLAGE PROFESSIONAL DR S
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City | OPELIKA
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State | AL
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Zip | 36801-4742
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Country | US
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Telephone | 334-528-6670
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Fax | 334-528-6671
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD.36982
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD.36982
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD.36982
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License Number State | AL
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