MR. TREVOR J WALLACE (NPI# 1396281200) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396281200 |
| Entity Type | Individual |
| Full Name | MR. TREVOR J WALLACE |
| Credential | PA-C |
| Practice Address |
61 Whitcher St Ne Suite 1100 Marietta GA 30060-1176 |
| Practice Telephone | 7704223290 |
| Practice Fax Number | 7704220287 |
| Mailing Telephone | 7704223290 |
| Mailing Fax Number | 7704220287 |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-03-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 8236 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 003185899A | 05 | |
| GA | 003185899C | 05 | |
| GA | 003185899B | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003339094 | Trevor Dewitt Wallace | Contractor | 571 Eva Kennedy Rd Apt 8, Suwanee, GA 30024-3008 | 2017-07-20 |
| 1609343870 | Trevor Robert Wallace | Behavior Technician | 1855 2nd St Ste B, Concord, CA 94519-2623 | 2018-10-25 |
| 1568965044 | Trevor Wallace | Case Manager/Care Coordinator | 1201 Champlain St, Toledo, OH 43604-1907 | 2018-03-12 |
| 1417386350 | Trevor Wallace | Case Manager/Care Coordinator | 315 Record St Ste 103, Reno, NV 89512-3327 | 2013-11-01 |
| 1538295142 | Trevor B. Wallace | Marriage & Family Therapist | 6833 Stockton Blvd, Ste 485, Sacramento, CA 95823-2372 | 2007-02-26 |
| Street Address |
61 WHITCHER ST NE SUITE 1100 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-1176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124014568 | Richard W Cohen | Orthopaedic Surgery | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2005-09-21 |
| 1376050955 | Gina M Soto | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2018-01-04 |
| 1477062594 | Anna Swanson Bouchard | Nurse Practitioner | 61 Whitcher St Ne, Marietta, GA 30060-1176 | 2017-09-20 |
| 1720537327 | Taylor Dellinger | Nurse Practitioner | 61 Whitcher St Ne, Suite 3110, Marietta, GA 30060-1176 | 2016-09-25 |
| 1164871117 | Georgiana Massad | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2016-06-10 |
| 1134593809 | Sarah Applegarth | Physician Assistant | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2015-11-18 |
| 1336543529 | Wellstar Medical Group, LLC | Internal Medicine | 61 Whitcher St Ne, Suite 4100b, Marietta, GA 30060-1181 | 2014-10-16 |
| 1346660198 | Catherine Chmiel | Nurse Practitioner | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2014-04-20 |
| 1467885863 | Wellstar Medical Group, LLC | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 61 Whitcher St Ne, Suite 4100, Marietta, GA 30060-1176 | 2013-08-21 |
| 1306186705 | Jon Barry Stanley | Physician Assistant | 61 Whitcher St Ne, Suite 4120, Marietta, GA 30060-1176 | 2013-02-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053928721 | Lynn Xinhui Guan | Physician Assistant | 1121 Johnson Ferry Rd Ste 420, Marietta, GA 30068-5420 | 2020-09-28 |
| 1902416035 | Courtney Taylor Warfel | Physician Assistant | 4561 Trickum Rd Ne, Marietta, GA 30066-1364 | 2020-08-04 |
| 1750914867 | Julea Grace Radford | Physician Assistant | 2421 Shiloh Dr Sw, Marietta, GA 30064-4257 | 2020-02-17 |
| 1447880984 | Madison Alice Dooley | Physician Assistant | 3084 Moss Stone Ln, Marietta, GA 30064-6415 | 2020-01-23 |
| 1538704820 | Spencer David Wenzel | Physician Assistant | 919 Rosedale Dr, Marietta, GA 30066-5431 | 2019-11-11 |
| 1578044046 | Michelle Han | Physician Assistant | 2520 Windy Hill Rd Se Ste 301, Marietta, GA 30067-8695 | 2018-08-23 |
| 1932624434 | David Johann Hoover | Physician Assistant | 400 Matthew St Ste 208, Marietta, OH 45750-1656 | 2017-08-07 |
| 1174059877 | Thomas Ryan Cooke | Physician Assistant | 2169 Freydale Rd Se, Marietta, GA 30067-7070 | 2017-05-02 |
| 1790168284 | Alissa R. Mcgee | Physician Assistant | 790 Church Street, Suite 335, Marietta, GA 30060-7282 | 2015-07-02 |
| 1063832749 | Patricia Chu Mulder | Physician Assistant | 2639 Morgan Lake Dr Ne, Marietta, GA 30066-5611 | 2014-04-22 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.