Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JACOB WALLIS
ActiveJACOB WALLIS is a Physician Assistant healthcare provider located in FAYETTEVILLE, Georgia. NPI 1568118172 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · FAYETTEVILLE, GA
Registration Details
- NPI Number
- 1568118172
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Feb 23, 2022 (4.4734070662349 yrs)
- Last Updated
- Nov 21, 2024
- License
-
4879 (TN)
Practice Information
- Address
-
104 N PARK DRFAYETTEVILLE, GA, 302141645Browse GA providers · Browse ZIP 30214
- Phone
- 4709445290
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in FAYETTEVILLE, GA
| Name | Credential | NPI |
|---|---|---|
| DONICA J DAVIS | PAC | 1447246780 |
| MRS. PATRICIA MARIE ELLIS | PA-C | 1346237450 |
| JOAN S SANDERS | P.A.-C | 1952385296 |
| KRISTEN N BUSBY | PA-C | 1386614477 |
| PATRICIA T. PERRY | PA | 1568438216 |
| PATRICIA C PURNELL | PA | 1184667156 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.