Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Amanda Daniel Wallace, PA-C

Individual provider Physician Assistant · NPI 1518249838

Amanda Daniel Wallace, PA-C is a Physician Assistant in Gainesville, Georgia. Graduated from Medical College of Georgia School of Medicine in 2011, 15 years ago. Practices with Northeast Georgia Community Physicians LLC, a 125-clinician group, works from 9 locations and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
15
Trained at
Medical College of Georgia School of Medicine
Licensed in
GA
In the registry since
2011
Specialties on file
3
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

655 Jesse Jewell Pkwy SE Ste B
Gainesville, GA 30501-3854
Phone: (770) 532-7092
Fax: (770) 536-0383
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (8)

  • 1765 Old West Broad St, Athens, GA 30606-2853 — (706) 549-1663
  • 1400 River Pl, Braselton, GA 30517-5600 — (770) 532-7092
  • 1270 Friendship Rd, Braselton, GA 30517-5630 — (678) 207-4477
  • 835 Austin Dr, Demorest, GA 30535-4513 — (706) 754-8518
  • 801 Austin Dr, Demorest, GA 30535-4513 — (706) 754-8066
  • 743 Spring St Ne, Gainesville, GA 30501-3715 — (770) 532-7092
  • 725 Jesse Jewell Pkwy Se, Gainesville, GA 30501-3834 — (770) 532-7092
  • 1945 Beverly Rd, Gainesville, GA 30501-2034 — (770) 532-7092

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 6247 (GA)
Physician Assistant Taxonomy 363A00000X · Licence 6247 (GA)
Medical Physician Assistant Taxonomy 363AM0700X · Licence 6247 (GA)

Record details

NPI number1518249838
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedSeptember 13, 2011
Last updated in NPPESSeptember 26, 2023
Certification dateSeptember 26, 2023
Mailing addressPo Box 658, Gainesville, GA 30503-0658

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMEDICAL COLLEGE OF GEORGIA SCHOOL OF MEDICINE
Graduated 2011 (15 years in practice)
Group practice Northeast Georgia Community Physicians Llc — 125 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

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