Deborah A Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN040043 Issued in GA

Practice address

1000 Medical Center Blvd
Lawrenceville, GA 30046-0000

Phone

(770) 277-3056

Fax

(855) 204-5244

NPI assigned

Jun 14, 2006

Last updated

Apr 29, 2014By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• American Anesthesiology Associates of Georgia, LLC

  • Anesthesiology Physician
  • Stone Mountain, GA
  • NPI 1528068673
  Medicare reassignment NPD
• North Atlanta Professional Services LLC

  • Psychologist
  • Atlanta, GA
  • NPI 1316959869
  Medicare reassignment NPD
• Sleep Ezzy

  • Pain Medicine (Anesthesiology) Physician
  • Lawrenceville, GA
  • NPI 1154852820
  Medicare reassignment NPD
• Georgia Vascular Specialists PC

  • Vascular Surgery Physician
  • Atlanta, GA
  • NPI 1558420778
  NPD
• Georgia Interventional Pain - D LLC

  • Ambulatory Surgical Clinic/Center
  • Decatur, GA
  • NPI 1043660442
  NPD (past)

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398729600000",
    "number": "1184667388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "954-839-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300460000",
            "telephone_number": "770-277-3056",
            "fax_number": "855-204-5244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "DEBORAH",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-14",
        "last_updated": "2014-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "R040043",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN040043",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000511167C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Whitney Walker
• Alexa Royal Wall
• Natarsha Monyanmah Wall, NP
• Wallace F. Martin, M.D.
• Candice E Wallace, MD
• Julia Danielle Wallace, OTR/L
• Vivian Dyanne Wallace, M.ED.
• Lisa Nicole Walls, M.ED.
• Megan Walton, LPN
• Phillip G Walton, M.D.

• Certified Registered Nurse Anesthetist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.