Active NPI
Shawn Corbet Wallace, PHARMD
- Pharmacist
- Cartersville, GA
National Provider Identifier
1609085232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 020571
- Practice address
- 954 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129 - Phone
- (770) 383-3055
- NPI assigned
- May 21, 2007
- Sex
- Male
- Sole proprietor
- No
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 020571 | GA | MD | Pharmacist |
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 |
|---|---|---|---|---|
| Pharmacist | 183500000X | 020571 | GA | Primary |
Addresses
Primary practice location
954 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129
Mailing address
471 Highlands Loop
Woodstock, GA 30188-5393
Phone (770) 592-1707
NPI Registry JSON
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1609085232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "471 HIGHLANDS LOOP",
"city": "WOODSTOCK",
"state": "GA",
"postal_code": "301885393",
"telephone_number": "770-592-1707"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "954 JOE FRANK HARRIS PKWY SE",
"city": "CARTERSVILLE",
"state": "GA",
"postal_code": "301202129",
"telephone_number": "770-383-3055"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "SHAWN",
"middle_name": "CORBET",
"credential": "PHARMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-21",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "GA",
"license": "020571",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cartersville, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.