Provider Demographics
NPI:1902030372
Name:WALLACE, ANNA HOLLMANN (MD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:HOLLMANN
Last Name:WALLACE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:HOLLMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 ACCELERATOR WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-3078
Mailing Address - Country:US
Mailing Address - Phone:865-546-2663
Mailing Address - Fax:865-546-9047
Practice Address - Street 1:1600 ACCELERATOR WAY STE 200
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-3078
Practice Address - Country:US
Practice Address - Phone:865-546-2663
Practice Address - Fax:865-546-9047
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54087207XX0801X, 207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003147570AMedicaid
TNQ022105Medicaid
TN103I209653Medicare PIN