Wendy Stallworth

Primary specialty

ProsthetistTaxonomy code 224P00000X

License

CO125001 Issued in GA

Practice address

2365 Spring Rd SE Ste 215
Smyrna, GA 30080-2632

Phone

(513) 400-8349

NPI assigned

Oct 16, 2023

Sex

Female

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

State licenses

Practice roles

Locations

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.

• The Ajani Brand LLC

  • Durable Medical Equipment & Medical Supplies
  • Smyrna, GA
  • NPI 1194592618
  NPD Authorized official
• The Ajani Brand LLC

  • Prosthetic/Orthotic Supplier
  • Smyrna, GA
  • NPI 1730956269
  NPD Authorized official

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

{
    "created_epoch": "1697414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725840000000",
    "number": "1710769609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 WALTON WAY SE",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300823854",
            "telephone_number": "513-400-8349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2365 SPRING RD SE STE 215",
            "city": "SMYRNA",
            "state": "GA",
            "postal_code": "300802632",
            "telephone_number": "513-400-8349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "WENDY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-10-16",
        "last_updated": "2024-09-09",
        "certification_date": "2024-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224P00000X",
            "taxonomy_group": "",
            "desc": "Prosthetist",
            "state": "GA",
            "license": "CO125001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia McWhorter Spicknall, SLP
• Spinal Bracing, Inc
• Sprout Pediatric Nutrition LLC
• Andree Denise St Martin, LPC
• St Paul Medical Inc
• Adriana Torres Stanley, LPC
• Stanton Optical
• Star Optometry Ga LLC (InFocus Eyecare)
• Star Optometry Ga LLC (InFocus Eyecare)
• Christopher Randall Stebbins, L.C.S.W.

• Prosthetist in Smyrna, GA
• Providers in Smyrna, GA by specialty
• Prosthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2024; 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.