Kaci Waller, C-AA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

Practice address

2637 Arbor Glen PL
Marietta, GA 30066-4274

Phone

(229) 589-7427

NPI assigned

Jan 27, 2023

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Enrollment records 1

Specialty

Anesthesiology Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ams Southeast LLCGroup PAC ID 3870880792, 83 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Colquitt Regional Medical Center Hospital, Moultrie, GA, CCN 110105

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

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.

• Ams Southeast LLC

  • Anesthesiology Physician
  • Pensacola, FL
  • NPI 1487107157

  Anesthesiologist Assistant, GA

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Colquitt Regional Medical Center

  • General Acute Care Hospital
  • Moultrie, GA
  • NPI 1912099094
  Care Compare affiliation
• Colquitt Regional Medical Center

  dba Colquitt Regional Geriatric Behavioral Health

  • Psychiatric Hospital Unit
  • Moultrie, GA
  • NPI 1982295036
  Care Compare affiliation

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1674777600000",
    "number": "1972219442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2637 ARBOR GLEN PL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300664274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2637 ARBOR GLEN PL",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300664274",
            "telephone_number": "229-589-7427"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "KACI",
        "credential": "C-AA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-01-27",
        "last_updated": "2023-01-27",
        "certification_date": "2023-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tashianna Walker, COA
• Caprinxia Wallace
• Dawn M.L. Wallace
• Julie Wallace, RD,LD,CSP
• Kimberly Wallace, LPC
• Richardd D Walls, D.M.D.
• Marie Walsh- Young, LPN, LMT
• Ashlie Walsh
• Colleen Elizabeth Walsh, LPC
• Megan Walsh, MSW

• Anesthesiologist Assistant in Marietta, GA
• Providers in Marietta, GA by specialty
• Anesthesiologist Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.