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

John Gray Wallace, MD

Individual provider Family Medicine Physician · NPI 1831486596

John Gray Wallace, MD is a Family Practice in Kosciusko, Mississippi. Graduated from University of Mississippi School of Medicine in 2011, 15 years ago. Practices with Premier Medical Group of Mississippi LLC, a 31-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Mississippi.

Years since qualifying
15
Trained at
University of Mississippi School of Medicine
Licensed in
MS
In the registry since
2011
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

332 Highway 12 W
Kosciusko, MS 39090-3209
Phone: (662) 289-1800
Fax: (662) 289-2486
Show map & directions

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

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 22522 (MS)

Record details

NPI number1831486596
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJuly 1, 2011
Last updated in NPPESSeptember 22, 2014
Mailing addressPo Box 23996, Jackson, MS 39225-3996

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolUNIVERSITY OF MISSISSIPPI SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Premier Medical Group Of Mississippi Llc — 31 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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