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

Mr. Richard Jeremy Wallace, PA-C

Individual provider Physician Assistant · NPI 1841583788

Mr. Richard Jeremy Wallace, PA-C is a Physician Assistant in Williston, South Carolina. Registered with an NPI since 2011.

In the registry since
2011
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Practice location Address checks out

13649 Church St
Williston, SC 29853
Phone: (803) 266-0060
Fax: (803) 266-0042
Show map & directions

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

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1841583788
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 25, 2011
Last updated in NPPESJanuary 11, 2024
Certification dateJanuary 11, 2024

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