Michael Lee Waller, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

54290 Issued in GA

Practice address

950 Sanders Rd
Cumming, GA 30041-5960

Phone

(770) 889-5030

Fax

(770) 889-5030

NPI assigned

Aug 9, 2006

Last updated

Jun 13, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Hospital Physician Services - Southeast Professional Corporation

  • Hospitalist Physician
  • Monroe, GA
  • NPI 1760410385
  NPD (past)

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

{
    "created_epoch": "1155081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307923200000",
    "number": "1881604767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 SANDERS ROAD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300416183",
            "telephone_number": "770-889-5030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 SANDERS RD",
            "city": "CUMMING",
            "state": "GA",
            "postal_code": "300415960",
            "telephone_number": "770-889-5030",
            "fax_number": "770-889-5030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "MICHAEL",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-09",
        "last_updated": "2011-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "54290",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "938550931A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walkers Unrivaled Surgical Services
• Amy Catherine Wallace, O.T.
• Jennifer Wallace, MS, LPC, RPT
• Oscar Russell Wallace
• Sara W Wallace, NP-C
• Suzanne Waller, L.P.C.
• Erin Blair Wallis, CSC
• Nancy Walsh, MD
• Colin Walters, DMD
• Dustin Walton

• Cardiovascular Disease Physician in Cumming, GA
• Providers in Cumming, GA by specialty
• Cardiovascular Disease Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2011; 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.