Individual provider · Type 1 NPI

Marysa P. Wallace, AGNP-C

Nurse Practitioner · Fayetteville, GA

NPI number 1932989357 Active

Practice location

132 Old Norton Rd Ste 200
Fayetteville, GA 30215-4873

Call (678) 817-1117 Map

Fax (678) 817-0823

Mailing address

1835 Savoy Dr Ste 203
Atlanta, GA 30341-1073

Specialties and licenses

TaxonomyCodeLicense
Nurse Practitioner Primary 363L00000XRN259981 (GA)

Nurse Practitioner: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance wit…

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About NPI 1932989357

Marysa P. Wallace, AGNP-C's National Provider Identifier is 1932989357, issued on Oct 3, 2023. The primary taxonomy on file is Nurse Practitioner (363L00000X), and the practice location is in Fayetteville, GA. The record was last updated on Aug 14, 2024.