TREVOR DEWITT WALLACE (NPI# 1003339094) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003339094 |
| Entity Type | Individual |
| Full Name | TREVOR DEWITT WALLACE |
| Practice Address |
571 Eva Kennedy Rd Apt 8 Suwanee GA 30024-3008 |
| Practice Telephone | (770) 369-1497 |
| Mailing Telephone | 7703691497 |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2017-07-20 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171W00000X | Contractor | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609343870 | Trevor Robert Wallace | Behavior Technician | 1855 2nd St Ste B, Concord, CA 94519-2623 | 2018-10-25 |
| 1568965044 | Trevor Wallace | Case Manager/Care Coordinator | 1201 Champlain St, Toledo, OH 43604-1907 | 2018-03-12 |
| 1396281200 | Trevor J Wallace | Physician Assistant | 61 Whitcher St Ne, Suite 1100, Marietta, GA 30060-1176 | 2017-01-17 |
| 1417386350 | Trevor Wallace | Case Manager/Care Coordinator | 315 Record St Ste 103, Reno, NV 89512-3327 | 2013-11-01 |
| 1538295142 | Trevor B. Wallace | Marriage & Family Therapist | 6833 Stockton Blvd, Ste 485, Sacramento, CA 95823-2372 | 2007-02-26 |
| Street Address |
571 EVA KENNEDY RD APT 8 |
| City | SUWANEE |
| State | GA |
| Zip Code | 30024-3008 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356996565 | Stephanie Arkin | Student in an Organized Health Care Education/Training Program | 25 Old Peachtree Rd Nw, Suwanee, GA 30024 | 2019-08-05 |
| 1164989638 | Laquitta Craft | Registered Nurse | 2855 Lawrenceville Suwanee Road Suite 330/340, Suwanee, GA 30024 | 2019-02-21 |
| 1467937235 | Greater Atlanta Monitoring, LLC | Electrodiagnostic Medicine | 3651 Peachtree Ste E. #331, Suwanee, GA 30024 | 2018-09-27 |
| 1760963482 | Esther Natacha Lafontant | Public Health or Welfare | 3205 Maple Terrace Drive, Suwanee, GA 30024 | 2018-08-22 |
| 1740778463 | Immaculate Healthcare Solutions, LLC | Home Health | 970 Peachtree Industrial Blvd Ste 8, Suwanee, GA 30024 | 2018-04-27 |
| 1053819235 | Sean Wonsuk Jang | Chiropractor | 3370 Lawrenceville Suwanee Rd Ste 118, Suwanee, GA 30024 | 2018-01-23 |
| 1932628468 | Silver Health Services, Inc. | Case Manager/Care Coordinator | 2640 Westbury Court, Swanee, GA 30024 | 2017-09-15 |
| 1285159095 | April L. Rivers | Nurse Practitioner | 4411 Suwanee Dam Rd Ste 110, Suwanee, GA 30024 | 2017-08-14 |
| 1144743840 | Nabil Elkareh | Pharmacist | 5049 Tarry Glen Drive., Suwanee, GA 30024 | 2017-07-25 |
| 1720508294 | Robert A Finkel Dds PC | Clinic/Center | 1325 Satellite Blvd Nw Ste 1304, Suwanee, GA 30024 | 2017-06-26 |
| Find all providers in zip 30024 | ||||
| Taxonomy Code | 171W00000X |
| Grouping | Other Service Providers |
| Classification | Contractor |
| A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |
| Notes: Source: Websters New World Dictionary of the American Language, Second College Edition, William Collins + World Publishing Co., Inc., New York: 1974, p. 308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023620093 | Tracie R Valera | Contractor | 2979 Savannah Walk Ln, Suwanee, GA 30024-3658 | 2020-08-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952900011 | Tamekia Richardson | Contractor | 861 Frank Rd, Fitzgerald, GA 31750-9049 | 2020-10-20 |
| 1285232777 | Khrystal Wright | Contractor | 4016 Foxborough Blvd, Valdosta, GA 31602-6726 | 2020-10-15 |
| 1922605690 | Mary Sonya Jackson | Contractor | 5480 Hedge Brooke Pointe Nw, Acworth, GA 30101-7142 | 2020-10-06 |
| 1790392652 | Najee Shafi | Contractor | 100 Archstone Sq, Mcdonough, GA 30253-5820 | 2020-09-24 |
| 1144837071 | Angela M Bodie | Contractor | 406 Carrington Green Pkwy, Mcdonough, GA 30252-7693 | 2020-09-24 |
| 1841806841 | Ashley De Plato | Contractor | 3813 Robin Ln, Valdosta, GA 31605-5124 | 2020-09-16 |
| 1407462401 | Pamela Woodard | Contractor | 868 Cochise Trl Se, Conyers, GA 30094-4538 | 2020-09-16 |
| 1821603606 | Sherenda Lashawn Ellis | Contractor | 1859 Petite Lane, Lithonia, GA 30058 | 2020-09-09 |
| 1316551377 | Holland Consulting Practice LLC | Contractor | 6307 Towne Lake Hts, Woodstock, GA 30189-4245 | 2020-09-07 |
| 1003420571 | Antonio Jones | Contractor | 700 Martin Luther King Jr Dr Sw Apt 206, Atlanta, GA 30314-4143 | 2020-09-02 |
| 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.