Sara W Wallace, NP-C

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN183641 Issued in GA

Practice address

950 Sanders Rd
Cumming, GA 30041-5960

Phone

(678) 208-2446

Fax

(770) 887-1375

NPI assigned

Jan 25, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Alpharetta Internal Medicine Associates, PC

  • Primary Care Clinic/Center
  • Roswell, GA
  • NPI 1770799702
  Medicare reassignment NPD

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

{
    "created_epoch": "1485302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601942400000",
    "number": "1114464310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1380 UPPER HEMBREE RD",
            "city": "ROSWELL",
            "state": "GA",
            "postal_code": "300761146",
            "telephone_number": "770-475-2377",
            "fax_number": "770-442-0193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 SANDERS RD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415960",
            "telephone_number": "678-208-2446",
            "fax_number": "770-887-1375"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SARA",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-01-25",
        "last_updated": "2020-10-06",
        "certification_date": "2020-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN183641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaylyn Walker
• Walkers Unrivaled Surgical Services
• Amy Catherine Wallace, O.T.
• Jennifer Wallace, MS, LPC, RPT
• Oscar Russell Wallace
• Michael Lee Waller, MD
• Suzanne Waller, L.P.C.
• Erin Blair Wallis, CSC
• Nancy Walsh, MD
• Colin Walters, DMD

• Nurse Practitioner in Cumming, GA
• Providers in Cumming, GA by specialty
• Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.