Marlyn M. Wallace

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

RN182038 Issued in GA

Practice address

3073 Klondike Rd SW
Conyers, GA 30094-5660

Phone

(678) 558-3106

NPI assigned

Dec 5, 2018

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

Specialty

Nurse Practitioner

Education

Other, 2017

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlanta Plus Primary Care LLCGroup PAC ID 3072984111, 5 clinicians

Atlanta Plus Urgent CareGroup PAC ID 9133453368, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/GDAHBD

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.

• Atlanta Plus Primary Care LLC

  • Internal Medicine Physician
  • Conyers, GA
  • NPI 1265144414
  Medicare reassignment Care Compare group NPD
• Atlanta Plus Urgent Care

  • Urgent Care Clinic/Center
  • Conyers, GA
  • NPI 1588163638
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1543968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543968000000",
    "number": "1144790973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3073 KLONDIKE RD SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945660",
            "telephone_number": "678-558-3106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3073 KLONDIKE RD SW",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300945660",
            "telephone_number": "678-558-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARLYN",
        "middle_name": "M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-12-05",
        "last_updated": "2018-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN182038",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ana Maria Walker, RN
• Brett Walker, M.D.
• Carol W Walker, FNP, APRN
• Latisha Jones Walker, M.S.W.
• Mystery Mona Walker
• Mary D Walters, RD, LD
• Karen Walton, RBT
• Megan M Wandurraga, N.P.
• Donnie Ray Washington
• Jelani Tenoa Washington Sr., D.D.S.

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2018; 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.