Alan S Waller, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

018761 Issued in GA

Practice address

100 Mimosa Drive
Thomasville, GA 31792

Phone

(229) 226-8881

Fax

(229) 225-2165

NPI assigned

Jan 13, 2006

Last updated

Jun 25, 2015By 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 2

Addresses

Other identifiers 5

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.

• Archbold Medical Group, Inc.

  • Surgery Physician
  • Thomasville, GA
  • NPI 1831353036
  NPD (past)
• Early Memorial Hospital

  • Critical Access Hospital
  • Blakely, GA
  • NPI 1548214018
  NPD (past)
• South Georgia Surgical Associates, PC

  • Specialist
  • Thomasville, GA
  • NPI 1235245184
  NPD (past)

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

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435190400000",
    "number": "1962481226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MIMOSA DRIVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "31792",
            "telephone_number": "229-226-8881",
            "fax_number": "229-225-2165"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MIMOSA DRIVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "31792",
            "telephone_number": "229-226-8881",
            "fax_number": "229-225-2165"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "ALAN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2015-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "018761",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "018761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PEACH STATE",
            "identifier": "000394732A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "207450",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "110153553",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000394732A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000394732G",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Holly Waldrep, PT
• Heather H. Waldrop, DC
• Walgreen Co (Walgreens # 19880)
• Walgreen Co (Walgreens #11794)
• Jonathan Edward Walker, L.C.S.W.
• Bradley N Walter, MD
• Jaleishia Walton, LPN
• Jordan Maxwell Ward, MD
• Martha S. Ward, M.D.
• Timothy Ward, MD

• Surgery Physician in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.