NPI age
2 years
Enumerated 2023-10-03
● Active
Type 1 · Individual
Marysa P Wallace, AGNP-C
Wallace is 1 of 51 nurse practitioner providers in Fayetteville and 1 of 3206 in Georgia.
Primary specialty
Nurse Practitioner
Licensed in
GA
1 state
Status
Active
No deactivations on record
Last NPPES update
2024-08-14
Source: monthly bulk 2026-05
Sole proprietor
No
May be part of a larger org
How this provider compares
Across 3206 active nurse practitioner providers in Georgia.
NPI age
2 years
↓ 6 yr below median (8 yr)
State licenses
1 state
8% of peers hold multiple states
Subspecialties
0
30% of peers hold subspecialties
NPI lifetime · 2023 → 2026
2023-10Enumerated in NPPES
2023
2026
Where they practice
Practice location
132 Old Norton Rd Ste 200
Fayetteville, GA 302154873
Mailing address
1835 Savoy Dr Ste 203
Atlanta, GA 303411073
Specialties
-
Nurse Practitioner Primary(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...
Practice context
Part of a multi-provider practice. 4 other active providers share this practice address in NPPES.
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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.