NPI age
20 years
Enumerated 2006-05-05
● Active
Type 1 · Individual
MR. Terrell Richard Wallace JR., PA C
Wallace is 1 of 6 physician assistant providers in Warner Robins and 1 of 1333 in Georgia.
Primary specialty
Physician Assistant
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2012-09-18
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 1333 active physician assistant providers in Georgia.
NPI age
20 years
↑ 5 yr above median (15 yr)
State licenses
1 state
7% of peers hold multiple states
Subspecialties
0
21% of peers hold subspecialties
NPI lifetime · 2006 → 2026
2006-05Enumerated in NPPES
2006
2026
Where they practice
Practice location
136 South Houston Lake Road
Warner Robins, GA 31088
Mailing address
207 Esplanade Drive
Warner Robins, GA 31088
Specialties
-
Physician Assistant PrimaryDefinition to come...
Identifiers
| Type | Value | Notes |
|---|---|---|
| 01 | DC3326 | MCR RR |
| 01 | P00162033 | MCR RR |
Practice context
Solo or small practice. No other active providers share this practice address in NPPES.
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- Confirm the NPI on NPPES.The CMS registry is the system of record. Open NPPES →
- Check the state license is currently active.State licensing boards publish current status; NPPES does not.
- Confirm payer enrollment if billing.NPI presence does not guarantee active enrollment with Medicare, Medicaid, or commercial payers.