| Jacob Wallis, | |
|
104 N Park Dr, Fayetteville, GA 30214-1645 | |
| (470) 944-5290 | |
| Not Available |
| Full Name | Jacob Wallis |
|---|---|
| Gender | Male |
| Speciality | Physician Assistant |
| Experience | 5 Years |
| Location | 104 N Park Dr, Fayetteville, Georgia |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568118172 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363A00000X | Physician Assistant | 4879 (Tennessee) | Primary |
| Entity Name | Wellstar Medical Group LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558664003 PECOS PAC ID: 6709065402 Enrollment ID: O20110127000374 |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob Wallis, 206 Oxford Rd, New Albany, MS 38652-3115 Ph: (662) 534-2227 | Jacob Wallis, 104 N Park Dr, Fayetteville, GA 30214-1645 Ph: (470) 944-5290 |
Cynthia M Smith, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 1275 Highway 54 W Ste 201, Fayetteville, GA 30214 Phone: 770-461-3776 Fax: 770-461-3565 |
Mrs. Danna-grace Kennedy, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1255 Highway 54 W, Fayetteville, GA 30214 Phone: 770-716-0051 |
Ashlee Block, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 101 Yorktown Dr, Fayetteville, GA 30214 Phone: 678-593-9020 |
Nancy Welch Graf, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 101 Yorktown Dr Ste 102, Fayetteville, GA 30214 Phone: 770-460-4281 |
Dr. John Edward Donohue Ii, PHYSICIAN ASSISTANT Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 427 Porter Rd, Fayetteville, GA 30215 Phone: 770-716-8206 |
April Mackenzie Dumas, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 343 Rising Star Rd, Fayetteville, GA 30215 Phone: 770-315-6736 |
Ms. Angela Ward Cubin, CSA Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 1265 Highway 54 W Ste 103, Fayetteville, GA 30214 Phone: 470-514-5538 Fax: 470-514-5561 |