Mr Terrell Richard Wallace Jr, PA C - Physician Assistant in Warner Robins, GA

Mr Terrell Richard Wallace Jr, PA C is a Physician Assistant - Medical based in Warner Robins, Georgia. Mr Terrell Richard Wallace Jr is licensed to practice in Georgia (license number 002665) and his current practice location is 136 South Houston Lake Road, Warner Robins, Georgia. He can be reached at his office (for appointments etc.) via phone at (478) 953-1020.

NPI number for Mr Terrell Richard Wallace Jr is 1356399828 and his current mailing address is 207 Esplanade Drive, Warner Robins, Georgia. He does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1356399828.

Contact Information

Mr Terrell Richard Wallace Jr, PA C
136 South Houston Lake Road,
Warner Robins, GA 31088
(478) 953-1020
(478) 953-5406



Provider's Profile

Full NameMr Terrell Richard Wallace Jr
GenderMale
SpecialityPhysician Assistant - Medical
Location136 South Houston Lake Road, Warner Robins, Georgia
Accepts Medicare AssignmentsDoes not participate in Medicare Program. He may not accept medicare assignment.
  NPI Data:
  • NPI Number: 1356399828
  • Provider Enumeration Date: 05/05/2006
  • Last Update Date: 09/18/2012

Medical Identifiers

Medical identifiers for Mr Terrell Richard Wallace Jr such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1356399828NPI-NPPES
DC3326OtherMCR RR
P00162033OtherMCR RR

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363AM0700XPhysician Assistant - Medical 002665 (Georgia)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Terrell Richard Wallace Jr is NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mr Terrell Richard Wallace Jr, PA C
207 Esplanade Drive,
Warner Robins, GA 31088

Ph: (478) 922-3061
Mr Terrell Richard Wallace Jr, PA C
136 South Houston Lake Road,
Warner Robins, GA 31088

Ph: (478) 953-1020

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Physician Assistant Nurses in Warner Robins, GA

Le'tombria Seay, PA-C
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 125 Russell Pkwy, Warner Robins, GA 31088
Phone: 478-923-9730    
Amie Renee Daniels, PA
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 2054 Watson Blvd, Warner Robins, GA 31093
Phone: 478-918-0770    Fax: 478-918-0771
Andrew L. Ray, P.A.
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3051 Watson Blvd, Suite 525, Warner Robins, GA 31093
Phone: 478-953-4563    Fax: 478-953-4683
Ngoc Tram Dang,
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 1601 Watson Blvd, Warner Robins, GA 31093
Phone: 478-922-4281    
Nicole Alicia Lytle, PA
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 116 S Houston Rd, Warner Robins, GA 31088
Phone: 478-923-0131    
Mrs. Amanda Knauer Hale, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 114 Sutherlin Dr Ste 1c, Warner Robins, GA 31088
Phone: 478-287-6144    
Chad Alan Desbiens,
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 204 Bowen Dr, Warner Robins, GA 31088
Phone: 478-957-5465    

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