Catherine Wallace, MD

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

94669 Issued in GA

Practice address

243 Merchants Dr
Dallas, GA 30132-4700

Phone

(770) 230-9967

Fax

(770) 445-5860

NPI assigned

Jun 10, 2020

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

Other identifiers 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Urology

Education

Medical College of Georgia School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Selano Chiropractic Center, Inc.Group PAC ID 9032161864, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
• Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Selano Chiropractic Center, Inc.

  • Physician Assistant
  • Dallas, GA
  • NPI 1609096213
  Medicare reassignment Care Compare group NPD
• Selano Chiropractic Center Inc

  • Physician Assistant
  • Dallas, GA
  • NPI 1558008771
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Paulding Medical Center, Inc.

  • General Acute Care Hospital
  • Hiram, GA
  • NPI 1457329435
  Care Compare affiliation

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

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1154946606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 MERCHANTS DR STE A",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324749",
            "telephone_number": "404-543-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "243 MERCHANTS DR",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301324700",
            "telephone_number": "770-230-9967",
            "fax_number": "770-445-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CATHERINE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-10",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "GA",
            "license": "94669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME MAC JURISDICTION C",
            "identifier": "8101560001",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walgreen Co
• Walgreen Co
• Walgreen Co
• Aleah Walker, IBCLC
• Sheterra Maxcine Walker, MAMFT, LMFT, CYT-200
• Andrea Lynne Walter
• Catherine Wardlaw, M.A.
• Rachel Renee Warren, APC
• Warrens Home Inc
• Amanda Joy Watkins, LMSW

• General Practice Physician in Dallas, GA
• Providers in Dallas, GA by specialty
• General Practice Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; 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.