AMANDA DANIEL WALLACE


Address: 655 Jesse Jewell Pkwy Se Ste B, Gainesville, GA 30501-3854
Phone: 7705327092

AMANDA DANIEL WALLACE (NPI# 1518249838) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1518249838
Entity Type Individual
Full Name AMANDA DANIEL WALLACE
Credential PA-C
Practice Address 655 Jesse Jewell Pkwy Se Ste B
Gainesville
GA 30501-3854
Mailing Address Po Box 658
Gainesville
GA 30503-0658
Practice Telephone 7705327092
Practice Fax Number 7705360383
Mailing Telephone 7707181122
Mailing Fax Number 7705334786
Enumeration Date 2011-09-13
Last Update Date 2020-08-07
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 363A00000X Physician Assistant 6247 GA Physician Assistants & Advanced Practice Nursing Providers
N 363AM0700X Physician Assistant
Specialization: Medical
6247 GA Physician Assistants & Advanced Practice Nursing Providers
Y 363AS0400X Physician Assistant
Specialization: Surgical Technologist
6247 GA Physician Assistants & Advanced Practice Nursing Providers

Provider Secondary Practice Location

Address Telephone Number Fax Number
743 Spring St Ne, Gainesville, GA 305013715 7705327092 7705360383
725 Jesse Jewell Pkwy Se, Gainesville, GA 305013834 7705327092 7705360383
1270 Friendship Rd, Braselton, GA 305175630 6782074477 6782074478
1765 Old West Broad St, Athens, GA 306062853 7065491663 7065468792
1400 River Pl, Braselton, GA 305175600 7705327092 7705360383
1945 Beverly Rd, Gainesville, GA 305012034 7705327092 7705360383

Other Providers AMANDA WALLACE

NPI Name Taxonomy Address Enumeration
1366635245 Amanda Wallace Counselor 1907 Kristy Ct, Longmont, CO 80504-7387 2007-08-23
1952808024 Amanda Marie Wallace Case Manager/Care Coordinator 205 Main St E, Mohall, ND 58761-4014 2018-04-06
1306345848 Amanda Cheyenne Wallace Student in an Organized Health Care Education/Training Program 3640 Colonel Glenn Hwy, Dayton, OH 45435-0001 2018-02-11
1972015659 Amanda Wallace Behavior Technician 41521 W 11 Mile Rd, Novi, MI 48375-1803 2017-11-02
1154844041 Amanda Gail Wallace Nurse Practitioner 142 Depot Dr, South Shore, KY 41175-9306 2017-07-21
1578097341 Amanda Wallace Physical Therapist 2115 Dulles Dr, Lafayette, LA 70506-2652 2017-04-18
1649665977 Amanda Rose Wallace Psychiatry & Neurology 525 E 68th St, New York, NY 10065 2015-04-03
1972908010 Amanda Jo Wallace Psychologist 1500 N Westwood Blvd, Poplar Bluff, MO 63901-3318 2014-10-31
1578964888 Amanda Leigh Wallace Speech-Language Pathologist 928 W Market St, Tiffin, OH 44883-2529 2014-09-07
1053725952 Amanda Wallace Speech-Language Pathologist 40w310 Lafox Rd, Suite A1/b1, St Charles, IL 60175-6588 2014-06-18

Office Location

Street Address 655 JESSE JEWELL PKWY SE STE B
City GAINESVILLE
State GA
Zip Code 30501-3854

Providers in the same location

NPI Name Taxonomy Address Enumeration
1720435514 Gary Lee Chewning Nurse Practitioner 655 Jesse Jewell Pkwy Se Ste B, Gainesville, GA 30501-3854 2016-05-21
1629459136 Sook Kyung Yoon Physical Medicine & Rehabilitation 655 Jesse Jewell Pkwy Se Ste B, Gainesville, GA 30501-3854 2015-06-11
1306231535 Britta Adwoa Okyere Physical Medicine & Rehabilitation 655 Jesse Jewell Pkwy Se Ste B, Gainesville, GA 30501-3854 2015-04-03

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1437782851 Madison Raye Huth Physician Assistant 743 Spring Street Se, Gainesville, GA 30501 2020-02-13
1205487659 Grace M Walker Brown Nurse Practitioner 592 Medical Park Dr., Suite A, Gainesville, GA 30501 2019-09-26
1174086987 Nayab Ahmed Student in an Organized Health Care Education/Training Program 743 Spring Street, Suite 710, Gainesville, GA 30501 2019-04-09
1154881118 Ryan D Berry Student in an Organized Health Care Education/Training Program 734 Spring St Se Ste 710, Gainesville, GA 30501 2019-03-24
1609336304 Harper E Niver Student in an Organized Health Care Education/Training Program 743 Spring St., Suite 710, Gainesville, GA 30501 2019-03-20
1508336173 Bradee Burrell Aderholt Nurse Practitioner 663 Lanier Park Drive, Gainesville, GA 30501 2018-11-27
1578068359 Soammy Liz Matias Chiropractor 961 Green Street, Gainesville, GA 30501 2018-03-26
1811496896 Matthew Brown Speech-Language Pathologist 500 Spring St. Se Suite 101, Gainesville, GA 30501 2018-02-06
1346769825 Dr. Skeete & Associates of North Georgia, P.C. Optometrist 150 Pearl Nix Parkway, Suite D3a, Gainesville, GA 30501 2017-09-15
1932624723 M & B Imaging, PC Radiology 1640 Jesse Jewell Pkwy Se Ste 2, Gainesville, GA 30501 2017-08-14
Find all providers in zip 30501

Taxonomy Information

Taxonomy Code 363AS0400X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Surgical Technologist

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1659806248 Bluff Drive Medical Physician Assistant 954 Memorial Dr, Gainesville, GA 30501-2334 2017-04-21
1891085692 Brevard Surgical Solutions L.L.C. Physician Assistant 11302 Nw 31st Rd, Gainesville, FL 32606-6840 2011-04-13
1700180627 Julie Marie Haberski Physician Assistant 5630 Chestatee Landing Dr, Gainesville, GA 30506-6815 2011-01-06
1902853286 Jean Dietrich Megenity Physician Assistant 10026 Nw 12th Ln, Gainesville, FL 32606-8017 2006-05-30
1366417149 James William Becker Physician Assistant 200 S Enota Dr Ne Ste 360, Gainesville, GA 30501-3466 2006-02-23
1578547832 Dawn M Ferrer Physician Assistant 1296 Sims St Ste B, Gainesville, GA 30501-3873 2005-12-01
1962000950 Kelli O'shaughnessy Physician Assistant 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2020-10-13
1346847944 Nicholas Scott Duarte Physician Assistant 1600 Sw Archer Rd, Gainesville, FL 32610-3003 2020-10-06
1023643251 Robert J Poole Physician Assistant 743 Spring St Ne, Gainesville, GA 30501-3899 2020-03-09
1912541533 Samantha Morgan Kleiber Physician Assistant 1240 Jesse Jewell Pkwy Se Ste 300, Gainesville, GA 30501-3861 2019-11-06
Find all providers in GAINESVILLE

Competitor

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City GAINESVILLE
Zip Code 30501

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Dataset Information

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.

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