Carter Douglas Wallace, MD

Primary specialty

Pediatric Gastroenterology PhysicianTaxonomy code 2080P0206X

License

90501 Issued in GA

Practice address

2200 Hamilton Rd Ste B
Columbus, GA 31904-8856

Phone

(706) 655-8800

Fax

(205) 638-7455

NPI assigned

Sep 13, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Mr. Carter Wallace Professional name

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EHDHCD

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.

• Southeastern Endoscopy Center LLC

  • Ambulatory Surgical Clinic/Center
  • Columbus, GA
  • NPI 1932819554
  Medicare reassignment NPD
• Southeastern Gastroenterology Associates, PC

  • Gastroenterology Physician
  • Columbus, GA
  • NPI 1467196139

  Pediatric Gastroenterology

  NPD

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

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661126400000",
    "number": "1497037899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 7TH AVENUE SOUTH",
            "address_2": "SUITE S604",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "35233",
            "telephone_number": "205-638-9918",
            "fax_number": "205-638-7455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 HAMILTON RD STE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319048856",
            "telephone_number": "706-655-8800",
            "fax_number": "205-638-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "CARTER",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-13",
        "last_updated": "2022-08-22",
        "certification_date": "2022-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "AL",
            "license": "MD.35643",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "AL",
            "license": "MD.35643",
            "primary": false
        },
        {
            "code": "2080P0206X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Gastroenterology",
            "state": "GA",
            "license": "90501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CARTER",
            "last_name": "WALLACE",
            "prefix": "MR.",
            "credential": "MD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Shirley Walker
• Treyvion Walker
• Wendy Wall, NP-C
• Annette Wallace
• Brenda Lee Wallace
• David C. Wallace
• Douglas W Wallace, MD
• Katherine Marie Wallace, NP-C
• Crystal Shanta Waller, CRNA
• Debbie Waller

• Pediatric Gastroenterology Physician in Columbus, GA
• Providers in Columbus, GA by specialty
• Pediatric Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2022; 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.

Verify at the official NPI Registry.