Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Brian Charles Wallace

Individual provider Physician Assistant · NPI 1114378759

Brian Charles Wallace is a Physician Assistant in Mount Holly, North Carolina. Qualified in 2016, 10 years ago. Practices with ENT Carolina PA, a 14-clinician group and accepts Medicare assignment. Licensed in North Carolina.

Years since qualifying
10
Licensed in
NC
In the registry since
2016

Practice location Address checks out

125 W Catawba Ave
Mount Holly, NC 28120-1601
Phone: (704) 827-3014
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0010-06531 (NC)

Record details

NPI number1114378759
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedJune 24, 2016
Last updated in NPPESJuly 6, 2016
Mailing address125 W Catawba Ave, Mount Holly, NC 28120-1601

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Ent Carolina Pa — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in Mount Holly