Colby Evan Wallace, D.P.T.

Primary specialty

Neurology Physical TherapistTaxonomy code 2251N0400X

License

PT012499 Issued in GA

Practice address

12 Executive Park Dr NE
Atlanta, GA 30329-2206

Phone

(404) 778-3444

NPI assigned

Aug 17, 2016

Sex

Male

Sole proprietor

No

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

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Piedmont Orthopedics, LLCGroup PAC ID 4385963172, 191 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

91.62 of 100Reported as apm

Quality

83.25

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/327/brand/1/csg/21/fhir/r4

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.

• Piedmont Orthopedics, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1114317062
  Medicare reassignment Care Compare group NPD
• Atlanta Rehabilitation and Performance Center

  • Physical Therapy Clinic/Center
  • Cleveland, GA
  • NPI 1982797494
  Medicare reassignment NPD
• Orthoatlanta, LLC

  • Orthopaedic Surgery Physician
  • Newnan, GA
  • NPI 1851937114
  Medicare reassignment NPD
• Atlanta Rehabilitation and Performance Center

  • Physical Therapy Clinic/Center
  • Lawrenceville, GA
  • NPI 1013789205
  NPD
• Orthoatlanta, LLC

  • Orthopaedic Surgery Physician
  • Evans, GA
  • NPI 1679251920
  NPD
• Orthoatlanta, LLC

  • Orthopaedic Surgery Physician
  • Atlanta, GA
  • NPI 1982618294
  NPD

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

{
    "created_epoch": "1471392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1471392000000",
    "number": "1457806622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7208 NORTHLAKE HEIGHTS CIR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303452262",
            "telephone_number": "615-653-9596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 EXECUTIVE PARK DR NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303292206",
            "telephone_number": "404-778-3444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "COLBY",
        "middle_name": "EVAN",
        "name_prefix": "Dr.",
        "credential": "D.P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-08-17",
        "last_updated": "2016-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251N0400X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Neurology",
            "state": "GA",
            "license": "PT012499",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan M Wall, M.D.
• Bonita Lucille Wallace, LPC
• Bradley A Wallace, MD
• Caroline Barwick Wallace, CRNA
• Chasity Wallace
• Constance Wallace, M.S., LPC
• Felecia Zanetta Wallace, LMT, CMT
• Grant Wallace
• Gregory Stephen Wallace, MD
• Guy Wallace

• Neurology Physical Therapist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Neurology Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2016; 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.