RAY L WALLACE JR. (NPI# 1720014624) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720014624 |
| Entity Type | Individual |
| Full Name | RAY L WALLACE JR. |
| Credential | PA |
| Practice Address |
210 E. Derenne Avenue Savannah GA 31405 |
| Practice Telephone | 9126445300 |
| Practice Fax Number | 9126445270 |
| Mailing Telephone | 9126445300 |
| Mailing Fax Number | 9126445270 |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2019-05-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 000935 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 203066747B | 05 | |
| GA | 203066747A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 101 St Josephs Candler Dr Fl 1, Pooler, GA 313229579 | 9123556615 | 9123510645 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427440957 | Ray Linton Wallace IIi | Student in an Organized Health Care Education/Training Program | 2431 Mcdowell St, Apartment 3, Augusta, GA 30904-0401 | 2015-02-20 |
| Street Address |
210 E. DERENNE AVENUE |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31405 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508858887 | Markus Niederwanger | Pain Medicine | 210 E. Derenne Avenue, Savannah, GA 31405 | 2005-08-22 |
| 1285879502 | Tattnall Hospital Company, LLC | Occupational Therapist | 210 E. Derenne Avenue, Savannah, GA 31405-6736 | 2008-12-16 |
| 1558422642 | John Douglas Mccormick Jr. | Orthopaedic Surgery | 210 E. Derenne Avenue, Savannah, GA 31405 | 2006-12-12 |
| 1801837083 | Mariangeli M Hamilton | Nurse Practitioner | 210 E. Derenne Avenue, Savannah, GA 81405 | 2006-06-09 |
| 1457320566 | Andrew B Pandya | Physical Medicine & Rehabilitation | 210 E. Derenne Avenue, Savannah, GA 31405 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053918441 | Nicole Marie Tetro | Anesthesiology | Candler Hospital, 5353 Reynolds St, Savannah, GA 31405 | 2020-10-08 |
| 1154983880 | Nickes Medical Supply, LLC. | Durable Medical Equipment & Medical Supplies | 6020 Halsey St, Savannah, GA 31405 | 2019-07-02 |
| 1215593025 | Lee Ann Ryle | Nurse Practitioner | 5223 Paulsen St., Savannah, GA 31405 | 2019-05-16 |
| 1942765334 | Raegan Epps | Behavior Technician | 613 Stephenson Ave Ste 205, Savannah, GA 31405 | 2019-02-10 |
| 1679050454 | Phenomenal Nursing Service | Registered Nurse | 604 South St., 604 South St, Savannah, GA 31405 | 2018-07-24 |
| 1275029472 | Chelsea Amanda Keedy | Pharmacist | 836 E. 65th St., Medical Arts #4, Savannah, GA 31405 | 2018-07-11 |
| 1265933840 | Dwc-p LLC | Dentist | 5209 Paulsen Street, Savannah, GA 31405 | 2018-02-28 |
| 1386153005 | Aaron Shaw | Hearing Instrument Specialist | 5501 Abercorn St Ste E, Savannah, GA 31405 | 2017-09-26 |
| 1063946028 | Elizabeth Bentley Bruhn-danello | Dietitian, Registered | 836 East 65th Street, Medical Arts #4, Savannah, GA 31405 | 2017-04-17 |
| 1396278230 | Theresa Lynn George | Health Educator | 836 East 65 Th Street, Medical Arts #4, Savannah, GA 31405 | 2017-04-07 |
| Find all providers in zip 31405 | ||||
| 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 |
|---|---|---|---|---|
| 1306476965 | Alyssa Joyce Trenaman | Physician Assistant | 216 Lyman Hall, Savannah, GA 31410-1045 | 2020-01-23 |
| 1407311012 | Kia Elon Burch | Physician Assistant | 1004 Memorial Ln Ste 200, Savannah, GA 31410-1255 | 2019-02-07 |
| 1316430978 | Dawn Obrien | Physician Assistant | 4717 Hwy 80 E Ste H-1, Savannah, GA 31410-2943 | 2018-06-08 |
| 1265881189 | Mallory Williams | Physician Assistant | 11909 D. Mcauley Drive, Savannah, GA 31419 | 2016-06-10 |
| 1659727634 | Andrea L Yates | Physician Assistant | 10 Country Club Dr, Savannah, GA 31410-3406 | 2016-05-10 |
| 1861878233 | Roksana Grozeva | Physician Assistant | 900 Mohawk St Ste A, Savannah, GA 31419-1772 | 2015-08-07 |
| 1053791434 | Robert Earnest Sikes Jr. | Physician Assistant | 112 Steeplechase Rd, Savannah, GA 31405-1049 | 2015-06-01 |
| 1497160121 | Meredith Grace Lenichek | Physician Assistant | 4717 Us Highway 80 E, Savannah, GA 31410-2943 | 2014-06-20 |
| 1215364120 | Zachary K Johannesen | Physician Assistant | 5353 Reynolds Reynolds Street, Savannah, GA 31405-6015 | 2013-10-09 |
| 1588003651 | Brittany R. Tice | Physician Assistant | 509 Foundation Dr, Savannah, GA 31408-2215 | 2013-06-21 |
| Find all providers in SAVANNAH | ||||
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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.