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

William David Wallace, MD

Individual provider Diagnostic Radiology Physician · NPI 1679060438

William David Wallace, MD is a Diagnostic Radiology in Jackson, Mississippi. Qualified in 2018, 8 years ago. Practices with Lakeland Radiologists P A, a 29-clinician group and accepts Medicare assignment. Licensed in Mississippi.

Years since qualifying
8
Licensed in
MS
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

969 Lakeland Dr
Jackson, MS 39216-4606
Phone: (601) 200-2000
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Diagnostic Radiology Physician (primary) Taxonomy 2085R0202X · Licence 28885 (MS)

Record details

NPI number1679060438
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedApril 17, 2018
Last updated in NPPESJuly 12, 2024
Certification dateJuly 12, 2024
Mailing addressPo Box 23073, Jackson, MS 39225-3073

Medicare enrollment

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

Medicare specialtyDIAGNOSTIC RADIOLOGY
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Lakeland Radiologists P A — 29 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Jackson