Jamie Waller

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Practice address

723 Berea Ave
Gadsden, AL 35901-4155

Phone

(256) 312-8988

NPI assigned

Feb 24, 2016

Last updated

Feb 24, 2016By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Practice Builders, LLC

  dba Restore Medical Associates

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gadsden, AL
  • NPI 1801256458
  NPD (past) Authorized official

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

{
    "created_epoch": "1456272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456272000000",
    "number": "1679933220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1303 BELLEVUE DR",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359043622",
            "telephone_number": "256-295-8889"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 BEREA AVE",
            "city": "GADSDEN",
            "state": "AL",
            "postal_code": "359014155",
            "telephone_number": "256-312-8988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "JAMIE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-24",
        "last_updated": "2016-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Walker, CRNA
• Lewis Patterson Walker III, MD
• Lacey Renee Wall, OTR
• James N Wallace, MD
• Spencer Riley Wallace, CRNP
• Vicki Jo Wallis, MD
• Anastasia Walloga, DO
• Anderson Jay Ward III, CCP
• Kristina Marie Warren, CRNP
• Ricky Joe Warren, CRNA

• Clinic/Center in Gadsden, AL
• Providers in Gadsden, AL by specialty
• Clinic/Center in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2016; 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.