John Burton Wallace V, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

Practice address

1123 Clairmont Rd
Decatur, GA 30030-1207

Phone

(917) 392-6700

NPI assigned

Jul 12, 2013

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Jewish Board of Family and Children Services

  • Early Intervention Provider Agency
  • New York, NY
  • NPI 1235512989
  NPD (past)

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710720000000",
    "number": "1437590973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1736 OAKVIEW RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300304235",
            "telephone_number": "917-392-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 CLAIRMONT RD",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300301207",
            "telephone_number": "917-392-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "middle_name": "BURTON",
        "name_suffix": "V",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-07-12",
        "last_updated": "2024-03-18",
        "certification_date": "2023-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shevon Walker
• Alysa Gredel Wall, PSY.D.
• Jackie Hornbeck Wall, LPC
• Malissa Wall, D.O.
• Pearla Duncan Wall, LCSW
• Kathryn Wallace, PHARMD
• Paige Wallace, PHARMD
• Tonya Renee Wallace, FNP
• Yasmine Wallace
• Erika Karen Wallender

• Social Worker in Decatur, GA
• Providers in Decatur, GA by specialty
• Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.