Active NPI
Alysa Gredel Wall, PSY.D.
- Clinical Neuropsychologist
- Decatur, GA
National Provider Identifier
1881997468
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- PS-P000213
- Practice address
- 1276 McConnell Dr
Suite C
Decatur, GA 30033-3508 - Phone
- (404) 929-9009
- Fax
- (404) 929-9005
- NPI assigned
- Dec 21, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS-P000213 | GA | Primary |
Addresses
Primary practice location
1276 McConnell Dr
Suite C
Decatur, GA 30033-3508
Mailing address
1276 McConnell Dr
Suite C
Decatur, GA 30033-3508
Phone (404) 929-9009
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)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cognitive Rehabilitation of Georgia, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychologist
- Atlanta, GA
- NPI 1841525987
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1292889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1292889600000",
"number": "1881997468",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1276 MCCONNELL DR",
"address_2": "SUITE C",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333508",
"telephone_number": "404-929-9009",
"fax_number": "404-929-9005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1276 MCCONNELL DR",
"address_2": "SUITE C",
"city": "DECATUR",
"state": "GA",
"postal_code": "300333508",
"telephone_number": "404-929-9009",
"fax_number": "404-929-9005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "ALYSA",
"middle_name": "GREDEL",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-21",
"last_updated": "2010-12-21",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "GA",
"license": "PS-P000213",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Decatur, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.