NPIMap

Individual provider Active NPI

Sylvan M Waller, MD

  • Emergency Medicine Physician
  • Austell, GA
National Provider Identifier
1649227828
Registry record updated Sep 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
057512 Issued in GA
Practice address
3950 Austell Rd
Austell, GA 30106-1121
Phone
(770) 732-4000
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 057512 GA Primary

Addresses

Primary practice location

3950 Austell Rd
Austell, GA 30106-1121

Mailing address

5665 New Northside Dr NW
Suite 320
Atlanta, GA 30328-5831
Phone (770) 874-5400

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
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
057512GAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Peachtree Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Lagrange Emergency Physicians, LLC Emergency Medicine PastSince Feb 2, 2020 Accepting new patients
Scranton Emergency Group PC Emergency Medicine PastSince Apr 1, 2013 Accepting new patients
Brookville Emergency Group PC Emergency Medicine PastSince Dec 4, 2013 Accepting new patients
Ohio Emergency Physicians LLC Emergency Medicine Past Accepting new patients
Bamberg Emergency Group PC Emergency Medicine PastSince May 1, 2010 Accepting new patients
Colleton Emergency Group PC Emergency Medicine PastSince Aug 1, 2010 Accepting new patients
Elk Emergency Group PC Emergency Medicine PastSince Dec 1, 2013 Accepting new patients
Cartersville Emergency Physicians, LLC Emergency Medicine Past Accepting new patients
Blakely Emergency Group PC Emergency Medicine PastSince Oct 1, 2013 Accepting new patients
Lackawanna Emergency Group PC Emergency Medicine PastSince Apr 1, 2013 Accepting new patients
The Bortolazzo Group, LLC Emergency Medicine PastSince Feb 9, 2020 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations & group practices 12

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380067200000",
    "number": "1649227828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5665 NEW NORTHSIDE DR NW",
            "address_2": "SUITE 320",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303285831",
            "telephone_number": "770-874-5400",
            "fax_number": "770-874-5469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3950 AUSTELL RD",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061121",
            "telephone_number": "770-732-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "SYLVAN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2013-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "GA",
            "license": "057512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Austell, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.