Doctor profile · Federal record
Dr. Jacob Wallis
Physician Assistant · Fayetteville, GA
- NPI 1568118172
- 4 yrs on file
- Male
- Group practice
- No sanctions
Practice & contact
Operates at 3 locations .
- Primary practice
-
104 N Park Dr
Fayetteville, GA 302141645
(470) 944-5290 - Additional location
-
60 John C Breckenridge Cv
Adamsville, TN 383105089
(731) 646-0182 - Additional location
-
6515 Poplar Ave Ste 106
Memphis, TN 381194878
(901) 426-1090
fax (901) 426-1091 - Mailing address
-
206 Oxford RD
New Albany, MS 386523115
Credentials & registration
- NPI registered
- February 2022 — 4 yrs on file
- Profile last updated
- November 21, 2024
- Specialty taxonomy
- 363A00000X — NUCC code
- State license (1)
- Tennessee #4879
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1568118172. Last verified May 11, 2026.Open Payments
Industry payments received
All-time total
$19
Transactions
1
Manufacturers
1
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| IBSA Pharma Inc. | 1 | $19.05 |
By nature of payment
Frequently asked questions
What is Dr. Jacob Wallis's medical specialty?
Dr. Jacob Wallis practices Physician Assistant in Fayetteville, GA.
Where does Dr. Jacob Wallis practice?
Dr. Jacob Wallis practices at 104 N Park Dr, Fayetteville, GA 302141645. Office phone: 4709445290.
What is Dr. Jacob Wallis's NPI?
Dr. Jacob Wallis's National Provider Identifier (NPI) is 1568118172, issued by NPPES.