Jenny Anne Walldorf, M.D.

Primary specialty

Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X

License

77134 Issued in GA

Practice address

550 Peachtree St NE
Atlanta, GA 30308

Phone

(404) 686-5885

NPI assigned

May 29, 2012

Last updated

Oct 26, 2018By the provider in NPPES

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)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1338249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540512000000",
    "number": "1720348485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303082245",
            "telephone_number": "404-686-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 PEACHTREE ST NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30308",
            "telephone_number": "404-686-5885"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "685 W Baltimore St Rm 480",
            "address_2": "Center for Vaccine Development",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212011509",
            "country_code": "US",
            "telephone_number": "410-706-8695",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLDORF",
        "first_name": "JENNY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-05-29",
        "last_updated": "2018-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "GA",
            "license": "77134",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Paden Wallace, PT, DPT
• Timothy Brian Wallace II, M.D.
• Tracey Wallace
• Tracey C Wallace, M.D.
• Tracy Clark Wallace, PT
• Arielle Jill Wallenstein
• Joshua N Wallenstein, MD
• Bianca Nicole Waller, D.C.
• Brianna Faith Waller, PHARMD
• Edmund K Waller, M.D.

• Pediatric Infectious Diseases Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Pediatric Infectious Diseases Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2018; 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.