NPI age
4 years
Enumerated 2022-02-23
● Active
Type 1 · Individual
Jacob Wallis
Wallis is 1 of 59 physician assistant providers in Fayetteville and 1 of 4616 in Georgia.
Primary specialty
Physician Assistant
Licensed in
TN
1 state
Status
Active
No deactivations on record
Last NPPES update
2024-11-21
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 4616 active physician assistant providers in Georgia.
NPI age
4 years
↓ 4 yr below median (8 yr)
State licenses
1 state
9% of peers hold multiple states
Subspecialties
0
24% of peers hold subspecialties
NPI lifetime · 2022 → 2026
2022-02Enumerated in NPPES
2022
2026
Where they practice
Practice location
104 N Park Dr
Fayetteville, GA 302141645
Mailing address
206 Oxford Rd
New Albany, MS 386523115
Additional practice locations
2 secondary locations on file with NPPES.
Location 2
60 John C Breckenridge Cv
Adamsville, TN 383105089
Location 3
6515 Poplar Ave Ste 106
Memphis, TN 381194878
Specialties
-
Physician Assistant PrimaryA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally...
Practice context
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
Recently enumerated nearby: 2 new physician assistant providers have been added in Fayetteville in the last 180 days.
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Request a quote →How to verify this provider
- 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.