Jacob Wallis
Physician Assistant · Fayetteville, GA
Jacob Wallis is a physician assistant with a practice address in Fayetteville, Georgia, and NPI 1568118172, issued on Feb 23, 2022. Check the license with the Georgia board that licenses this profession; the Medicare figures below come from public CMS files.
- Name
- Jacob Wallis
- Primary taxonomy
- Physician Assistant 363A00000X
- License number
- 4879 TN
Self-reported in NPPES; status is on the state search - Practice location
- 104 N Park Dr, Fayetteville, GA 30214
- Phone
- (470) 944-5290
- Enumerated
- Feb 23, 2022
- Record last updated
- Nov 21, 2024
- Medicare enrollment
- Enrolled (PECOS I20260519004801); accepts Medicare assignment
- Entity
- Type 1 · individual
8 nearest physician assistant records → All 4,662 in Georgia → Look up another NPI →
Also registered at 104 N Park Dr
A shared address usually means a shared clinic or building; it does not show who employs whom.
- Robert Blake, D.D.S.,M.S.Orthodontics and Dentofacial Orthopedics Dentistry1407864440
Verify Jacob Wallis in five checks
- 1IdentityNPI record in CMS NPPESNPI lookupConfirmed in NPPES
- 2LicenseActive license and public ordersWhich Georgia board licenses this professionCheck the board
- 3Other statesLicenses and actions elsewhereDocInfo (FSMB)Not checked
- 4ExclusionsMedicare and Medicaid bansHHS-OIG exclusion listNot checked
- 5CertificationBoard certificationABMS AOA NCCPA AANPNot checked
Industry payments in 2024: $19.05
1 payment: food and beverage; the largest payer was Ibsa Pharma Inc. The 64,719 providers of this specialty with any payment received $841.65 on average. Payments are reported by manufacturers, not by the provider, and are not a sign of wrongdoing.
Source: CMS Open Payments, program year 2024 (openpaymentsdata.cms.gov); average among providers of this specialty with at least one payment.
Jacob Wallis among 4,662 physician assistant records in Georgia
Jacob Wallis is one of 4,662 physician assistant records with a practice address in Georgia. 75% of them appear in a Medicare file (Part D prescribing, MIPS, Open Payments or Medicare group billing); this one does. Its NPI, issued in 2022, is newer than 71% of them.
- NPI issued2022 · 71% of these records are older, 23% newer
- In a Medicare fileYes · 75% of these records are
- In the CMS Doctors and Clinicians fileYes · 59% of these records are
- Graduated2021 · median 2018 among the 2,761 with a school on file
- Record last updated2024 · 40% of these records were not updated in five years or more
Source: CMS NPPES, file of Aug 9, 2026, every record with primary taxonomy 363A00000X and a Georgia practice address; Medicare files: CMS Part D Prescribers 2024, MIPS 2023, Open Payments 2024, Doctors and Clinicians (data.cms.gov).
58 physician assistant records list a practice address in Fayetteville
They are 58 of the 1,527 NPPES records with a practice address in Fayetteville, and 4,662 physician assistant records in Georgia.
All 4,662 in Georgia → Every provider in Fayetteville → Physician Assistant nationwide →
The 8 physician assistant records with the nearest ZIP codes
- Esther Askew, PA-C, MPASFayetteville, GA 302141750461380
- Kristen Busby, PA-CFayetteville, GA 302141386614477
- Donica Davis, PACFayetteville, GA 302141447246780
- Laura Dean, PAFayetteville, GA 302141457434458
- Michelle Dupont, PA-CFayetteville, GA 302141104852078
- Patricia Ellis, PA-CFayetteville, GA 302141346237450
- Haley Gainor, PA-CFayetteville, GA 302141730101841
- Memorie Nichols, PA-CFayetteville, GA 302141144491937
Common questions
What is Jacob Wallis's NPI number?
Jacob Wallis's National Provider Identifier (NPI) is 1568118172, issued on Feb 23, 2022. An NPI identifies a provider in billing; it is not a license.
Where is Jacob Wallis located?
The NPPES record lists a practice address at 104 N Park Dr, Fayetteville, GA, 30214. Phone: (470) 944-5290. Providers update this record themselves, so call before visiting.
How can I verify Jacob Wallis's license?
Search the Georgia board that licenses this profession; the NPPES record confirms identity only.
Source: CMS National Plan and Provider Enumeration System (NPPES), file of Aug 9, 2026 (NPPES files on CMS.gov); NUCC Health Care Provider Taxonomy. Medicare files from data.cms.gov. An NPI identifies who bills; it is not a license.
Figures on PlainDoctor are read from the federal files each page names (CMS NPPES, Medicare Part D, MIPS, Open Payments; the HHS-OIG exclusion list only as counts) and from Census population estimates, with the file date shown beside them. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error. Data current as of Aug 9, 2026.