Active NPI
Anna Everett Wallace, PA-C
- Physician Assistant
- Savannah, GA
National Provider Identifier
1518249093
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006278
- Practice address
- 5356 Reynolds St Ste 201
Savannah, GA 31405-6019 - Phone
- (912) 232-9700
- NPI assigned
- Sep 12, 2011
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006278 | GA | Primary |
Addresses
Primary practice location
5356 Reynolds St Ste 201
Savannah, GA 31405-6019
Mailing address
5501 Abercorn St Ste D
Savannah, GA 31405-6915
Phone (912) 232-9700
Other practice location 1
6510 Seawright Dr
Savannah, GA 31406-2752
Phone (912) 232-9700 ext. 103
Other practice location 2
800 E 68th St
Savannah, GA 31405-4710
Phone (912) 232-9700 ext. 103
Other practice location 3
4 E Jackson Blvd
Savannah, GA 31405-5810
Phone (912) 355-1010
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003114943C | Medicaid | GA |
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)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1315785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601856000000",
"number": "1518249093",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5501 ABERCORN ST STE D",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056915",
"telephone_number": "912-232-9700",
"fax_number": "912-748-0270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5356 REYNOLDS ST STE 201",
"city": "SAVANNAH",
"state": "GA",
"postal_code": "314056019",
"telephone_number": "912-232-9700"
}
],
"practiceLocations": [
{
"address_1": "6510 Seawright Dr",
"address_purpose": "LOCATION",
"city": "Savannah",
"state": "GA",
"postal_code": "314062752",
"country_code": "US",
"telephone_number": "912-232-9700 x103",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "800 E 68th St",
"address_purpose": "LOCATION",
"city": "Savannah",
"state": "GA",
"postal_code": "314054710",
"country_code": "US",
"telephone_number": "912-232-9700 x103",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "4 E Jackson Blvd",
"address_purpose": "LOCATION",
"city": "Savannah",
"state": "GA",
"postal_code": "314055810",
"country_code": "US",
"telephone_number": "912-355-1010",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WALLACE",
"first_name": "ANNA",
"middle_name": "EVERETT",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-09-12",
"last_updated": "2020-10-05",
"certification_date": "2020-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "GA",
"license": "006278",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003114943C",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Savannah, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.