Doctor profile · Federal record
Dr. Jamie Wallace
Pediatrics Physician · Fayetteville, GA
- NPI 1205883147
- 20 yrs on file
- Female
- Group practice
- No sanctions
Practice & contact
- Primary practice
-
735 Glynn St S
Fayetteville, GA 302142049
(770) 461-4126
fax (770) 461-8852
Credentials & registration
- NPI registered
- May 2006 — 20 yrs on file
- Profile last updated
- July 8, 2007
- Specialty taxonomy
- 208000000X — NUCC code
- State license (1)
- Georgia #043044
- Medicaid
- GA #00794483A
Federal sanctions & exclusions
No sanctions, exclusions or revocations on file
Checked against OIG LEIE on NPI 1205883147. Last verified May 11, 2026.Open Payments
Industry payments received
All-time total
$41
Transactions
3
Manufacturers
1
| Payer (manufacturer) | Industry | Txns | Amount |
|---|---|---|---|
| Corium, LLC | 3 | $41.33 |
By nature of payment
Frequently asked questions
What is Dr. Jamie Wallace's medical specialty?
Dr. Jamie Wallace practices Pediatrics Physician in Fayetteville, GA.
Where does Dr. Jamie Wallace practice?
Dr. Jamie Wallace practices at 735 Glynn St S, Fayetteville, GA 302142049. Office phone: 7704614126.
What is Dr. Jamie Wallace's NPI?
Dr. Jamie Wallace's National Provider Identifier (NPI) is 1205883147, issued by NPPES.