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JACQUELINE WALLACE
NPI 1154168482
Student in an Organized Health Care Education/Training Program in Atlanta, GA

Active since July 12, 2024PECOS Enrolled
1364 CLIFTON RD NE, ATLANTA, GA 30322(404) 712-2000 Get Directions Write a Review

NPPES record last updated: April 3, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 3, 2025, Jul 12, 2024 (2 updates tracked since 2024).

About Jacqueline Wallace NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACQUELINE WALLACE (NPI 1154168482) is an individual student in an organized health care education/training program in Atlanta, Georgia and active in the NPI registry since July 2024. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1154168482
Entity TypeIndividualFemale
Primary Taxonomy390200000X
Provider Legal NameJACQUELINE WALLACE
Location Address1364 CLIFTON RD NEAtlanta, GA 30322-6504
Mailing Address1745 Derry Ave SwAtlanta, GA 30310-1503 · (978) 473-1576
Phone(404) 712-2000
Sole ProprietorNo
Enumeration DateJuly 12, 2024
Last NPPES UpdateApril 3, 20252 updates tracked since enumeration
NPPES CertifiedApril 3, 2025
✔ NPI 1154168482 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
1364 CLIFTON RD NE, Atlanta, GA 30322
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Other Names 1

Other Name (5)Jackie Wallace

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jacqueline Wallace is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer– Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GREGORY WESTON
Student in an Organized Health Care Education/Training Program
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 727-5658
RUTH FLAHERTY CCC-SLP
Physician Assistant
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 712-2000
JENNIFER MARIE SCHNETZER RN
Nurse Anesthetist, Certified Registered
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (679) 378-1093
PETER MORAN PHARMD
Pharmacist (Critical Care)
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 712-2000
SARAH ELIZABETH DUNSEATH MD
Anesthesiology (Critical Care Medicine)
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 778-7777
DUYEN M VO PHARMD
Pharmacist (Pharmacotherapy)
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 712-7273
CHRISTINE CARPENTER
Anesthesiologist Assistant
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 712-2000
DR. CHRISTOPHER VINCENT BARRY MD, PHD, MPH
Student in an Organized Health Care Education/Training Program
1364 CLIFTON RD NE
ATLANTA, GA 30322
Dekalb County (404) 727-5658

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacqueline Wallace's NPI number?

The NPI number for Jacqueline Wallace is 1154168482. It was assigned to this individual provider in the NPPES registry on July 12, 2024. The provider is also known as Jackie Wallace.

Where is Jacqueline Wallace located?

Jacqueline Wallace practices at 1364 Clifton Rd NE, Atlanta, GA 30322. The listed phone number is (404) 712-2000.

What is Jacqueline Wallace's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacqueline Wallace enrolled in Medicare?

Yes. Jacqueline Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacqueline Wallace was last updated on April 3, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.