Active NPI
Jamarius Waller
- Cardiovascular Disease Physician
- Atlanta, GA
National Provider Identifier
1376293936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cardiovascular Disease Physician
- License
- 99445
- Practice address
- 49 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3049 - Phone
- (404) 778-7777
- NPI assigned
- Mar 26, 2022
- Last updated
- Oct 11, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | 99445 | GA | Primary |
Addresses
Primary practice location
49 Jesse Hill Jr Dr SE
Atlanta, GA 30303-3049
Mailing address
5151 Parkway Dr
Jackson, MS 39211-4354
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220712004100 | GA | Order and Referring Only - Internal Medicine | 5991186603 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 99445 | GA | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1648252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728604800000",
"number": "1376293936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5151 PARKWAY DR",
"city": "JACKSON",
"state": "MS",
"postal_code": "392114354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "49 JESSE HILL JR DR SE",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303033049",
"telephone_number": "404-778-7777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLER",
"first_name": "JAMARIUS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-03-26",
"last_updated": "2024-10-11",
"certification_date": "2024-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "GA",
"license": "99445",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2024; 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.