Active NPI
Megan Elizabeth Wallace
- Behavior Technician
- Richmond Hill, GA
National Provider Identifier
1447725957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 053516240
- Practice address
- 784 Kelsall Dr
Richmond Hill, GA 31324-7706 - Phone
- (912) 308-0194
- NPI assigned
- Oct 11, 2018
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 053516240 | GA | Primary |
Addresses
Primary practice location
784 Kelsall Dr
Richmond Hill, GA 31324-7706
Mailing address
784 Kelsall Dr
Richmond Hill, GA 31324-7706
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 053516240 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539216000000",
"number": "1447725957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "784 KELSALL DR",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313247706"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "784 KELSALL DR",
"city": "RICHMOND HILL",
"state": "GA",
"postal_code": "313247706",
"telephone_number": "912-308-0194"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "MEGAN",
"middle_name": "ELIZABETH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-11",
"last_updated": "2018-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "053516240",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond Hill, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.