Individual provider
ALEXIS NICOLE WALLACE, MD
CMS NPPES lists ALEXIS NICOLE WALLACE as an individual provider record with NPI 1245856822. The current record reports a primary practice location in 1120 15TH ST, GA and primary taxonomy code 207R00000X.
Type 1 NPIs identify individual healthcare providers. How to read this profile
01
Practice locations
- Primary practice locationAUGUSTA UNIVERSITY MEDICAL CENTER1120 15TH ST, GA 30912
Only source-designated practice locations are shown here. Mailing addresses are not presented as practice locations.
02
Taxonomy information
207R00000XPrimary reported taxonomy
Taxonomy codes describe provider classifications reported to NPPES. Repeated identical codes are shown once, with primary-reported status preserved. They are not licenses, certifications, quality measures, or NPIFolio specialty labels. Read the taxonomy methodology.
03
NPI record information
- NPI status
- Enumerated in NPPES
- Enumeration date
- June 19, 2020
An NPI is a federal identifier. Enumeration and lifecycle information does not establish medical-license status, current practice, disciplinary history, provider quality, or whether a provider is accepting patients.