Freda Ellen Wall, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

002766 Issued in GA

Practice address

2001 Peachtree Rd NE
Ste 645
Atlanta, GA 30309-1476

Phone

(404) 350-0106

Fax

(404) 350-0176

NPI assigned

Jun 20, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Freda Ellen Sims Former name

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northside Urgent Care Holding LLCGroup PAC ID 4587984695, 77 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Northside Urgent Care Holding, LLC

  • Urgent Care Clinic/Center
  • Atlanta, GA
  • NPI 1679962237
  Medicare reassignment Care Compare group
• Piedmont Healthcare Inc

  • Cardiovascular Disease Physician
  • Stockbridge, GA
  • NPI 1376624940
  NPD
• Piedmont Providers LLC

  • Internal Medicine Physician
  • Jasper, GA
  • NPI 1548273592
  NPD
• Atlanta Brain and Spine Care, P.C.

  • Neurological Surgery Physician
  • Atlanta, GA
  • NPI 1659376275
  NPD (past)
• Piedmont Cardiology of Atlanta, LLC

  • Cardiovascular Disease Physician
  • Atlanta, GA
  • NPI 1275729691
  NPD (past)
• Radiology Associates of Atlanta, PA

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1528043718
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193011200000",
    "number": "1063417608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 PEACHTREE RD NE",
            "address_2": "STE 645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091476",
            "telephone_number": "404-350-0106",
            "fax_number": "404-350-0176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 PEACHTREE RD NE",
            "address_2": "STE 645",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091476",
            "telephone_number": "404-350-0106",
            "fax_number": "404-350-0176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "FREDA",
        "middle_name": "ELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-20",
        "last_updated": "2007-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "002766",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "GA",
            "license": "002766",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00236158",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "FREDA",
            "last_name": "SIMS",
            "middle_name": "ELLEN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walking in Purpose Inc.
• Walks of Life Wellness LLC
• Alice M Walkup, MS, BCBA
• Raymond R Walkup, M.D.
• Emily Wall, LCSW
• Janet R Wall, MD
• Mackenzie Nicole Wall
• Susan M Wall, M.D.
• Bonita Lucille Wallace, LPC
• Bradley A Wallace, MD

• Surgical Physician Assistant in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Surgical Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.