REX MICHAEL WALLACE NP
NPI 1629960315
Nurse Practitioner - Family in Athens, GA

Q: What is Rex Wallace's NPI number?

The NPI number for Rex Wallace is 1629960315. It was assigned to this individual provider in the NPPES registry on July 17, 2025.

Q: What is Rex Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Rex Wallace was last updated on October 9, 2025. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since July 17, 2025PECOS Enrolled

1061 DOWDY RD, ATHENS, GA 30606(706) 621-7555 Get Directions Write a Review

NPPES record last updated: October 9, 2025. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Rex Michael Wallace Np NPPES

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

REX MICHAEL WALLACE NP (NPI 1629960315) is an individual family provider in Athens, Georgia, licensed in Georgia (RN286080) and active in the NPI registry since July 2025. He is enrolled in Medicare PECOS and is a graduate of University Of Alabama School Of Medicine (2025).

NPPES Registry Identity

NPI1629960315

Entity TypeIndividualMale

Primary Taxonomy363LF0000X

Provider Legal NameREX MICHAEL WALLACECredential: NP

Location Address1061 DOWDY RDAthens, GA 30606-5700

Mailing Address964 Mauldin RdJefferson, GA 30549-1308 · (706) 654-8899

Phone(706) 621-7555

Sole ProprietorNo

Medical School CMSUniversity Of Alabama School Of MedicineGraduated 2025

Enumeration DateJuly 17, 2025

Last NPPES UpdateOctober 9, 2025

NPPES CertifiedOctober 9, 2025

✔ NPI 1629960315 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in GA · RN286080

1061 DOWDY RD, Athens, GA 30606

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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

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

PECOS PAC ID9133617012

PECOS Enrollment IDI20251022003703

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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30606 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$83.23 typical visit price

range $53.31 – $164.04

Typical copayment $20.80 (range $13.32 – $41.01)

Most-billed visit code 99203

Established Patient

$94.84 typical visit price

range $16.68 – $133.24

Typical copayment $23.71 (range $4.17 – $33.31)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.