RICHARD EDWIN WALLER (NPI# 1821001041) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821001041 |
| Entity Type | Individual |
| Full Name | RICHARD EDWIN WALLER |
| Credential | M.D. |
| Practice Address |
1024 Martin Luther King Drive Marks MS 38646-0289 |
| Mailing Address |
Po Box 289 Marks MS 38646-0289 |
| Practice Telephone | 6623263502 |
| Practice Fax Number | 6623262555 |
| Mailing Telephone | 6623263500 |
| Mailing Fax Number | 6623267077 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2017-03-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 07067 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 00115098 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417439233 | Richard Waller | Social Worker | 4155 E Harry St, Wichita, KS 67218-3725 | 2018-08-29 |
| 1871541862 | Richard Edmund Waller | Specialist | 14355 Sommerville Ct, Midlothian, VA 23113 | 2006-05-04 |
| 1689661944 | Richard R. Waller Jr. | Chiropractor | 563 Main St, Bolton, MA 01740-1300 | 2005-10-03 |
| Street Address |
1024 MARTIN LUTHER KING DRIVE |
| City | MARKS |
| State | MS |
| Zip Code | 38646-0289 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578665840 | Salvador Nierras Petilos | Family Medicine | 1024 Martin Luther King Drive, Marks, MS 38646-0289 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356765101 | Healthyland Adult Day Care, LLC | Custodial Care Facility | 227 Pecan Street, Marks, MS 38646 | 2014-02-14 |
| 1164573176 | Warrington Clinic, P.a. | Family Medicine | 1022 Martin Luther King Drive, Pob 289, Marks, MS 38646 | 2007-01-16 |
| 1205932076 | Medstock, Inc. | Durable Medical Equipment & Medical Supplies | 206 East Main Street, Marks, MS 38646 | 2006-09-16 |
| 1538167564 | Aaron E. Henry Community Health | Clinic/Center | Hwy 3 South, Marks, MS 38646 | 2005-07-13 |
| 1700020278 | Karanpreet S Bains | Internal Medicine | 411 Poplar Street, Marks, MS 38646 | 2009-04-28 |
| 1790873669 | Dons Pharmacy Inc | Pharmacist | 200 E Main St, Marks, MS 38646 | 2006-10-10 |
| 1114127099 | George Edward Farrell | Nurse Practitioner | 411 Poplar Street, Marks, MS 38646-0347 | 2007-07-19 |
| 1992979124 | Quitman County School District | Local Education Agency (LEA) | Highway 3 South, Marks, MS 38646-0805 | 2008-04-18 |
| 1417497306 | Golden Years Healthcare LLC | Respite Care | 201 Humphrey Ave, Marks, MS 38646-1122 | 2017-02-27 |
| 1225374903 | Parental Adult Daycare | PACE Provider Organization | 215 W Main St, Marks, MS 38646-1136 | 2012-12-27 |
| Find all providers in zip 38646 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164573176 | Warrington Clinic, P.a. | Family Medicine | 1022 Martin Luther King Drive, Pob 289, Marks, MS 38646 | 2007-01-16 |
| 1770941445 | Quitman County Hospital, LLC | Family Medicine | 1024 Martin Luther King Dr, Marks, MS 38646-1832 | 2016-02-09 |
| 1578665840 | Salvador Nierras Petilos | Family Medicine | 1024 Martin Luther King Drive, Marks, MS 38646-0289 | 2006-09-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900581 | Maegan Cook Bridges | Family Medicine | 312 Ridge Pointe Dr, Brandon, MS 39042-5035 | 2020-10-24 |
| 1003415266 | Christian Fortenberry | Family Medicine | 786 Lake Harbour Dr, Ridgeland, MS 39157-4303 | 2020-10-20 |
| 1457967226 | Tiffine Lynn Prisock | Family Medicine | 24978 Ms-15, Mathiston, MS 39752 | 2020-09-17 |
| 1851902860 | Jasmine Lester | Family Medicine | 538 Getwell Rd S, Hernando, MS 38632-9585 | 2020-08-12 |
| 1942810569 | Ericka Marcene Williams | Family Medicine | 1031 Northridge Rd Ste A, Baldwyn, MS 38824-1173 | 2020-08-07 |
| 1316557986 | Independent Healthcare Management, Inc | Family Medicine | 376 Simpson Highway 149 Ste 600, Magee, MS 39111-3572 | 2020-08-07 |
| 1164031373 | Rohith Reddy Guduru Venkata | Family Medicine | Delta Regional Medical Center, 1400 E Union St, Greenville, MS 38703 | 2020-07-24 |
| 1831707470 | Rebecca Holmes | Family Medicine | 42 Atley Holmes Rd # Rs, Jayess, MS 39641-8272 | 2020-07-20 |
| 1497373344 | Dhruval Patel | Family Medicine | 564 Cypress Ln Apt 11d, Greenville, MS 38701-7415 | 2020-07-08 |
| 1881211258 | Tiffany Chapman | Family Medicine | 905 S Frontage Rd, Meridian, MS 39301-6113 | 2020-07-01 |
| Find all providers with the same taxonomy | ||||
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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.