Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Freda Ellen Wall, PA-C

Individual provider Physician Assistant · NPI 1063417608

Freda Ellen Wall, PA-C is a Physician Assistant in Atlanta, Georgia. Qualified in 1995, 31 years ago. Practices with Northside Urgent Care Holding LLC, a 80-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
31
Licensed in
GA
In the registry since
2005
Specialties on file
2
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

2001 Peachtree Rd NE Ste 645
Atlanta, GA 30309-1476
Phone: (404) 350-0106
Fax: (404) 350-0176
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 002766 (GA)
Physician Assistant Taxonomy 363A00000X · Licence 002766 (GA)

Record details

NPI number1063417608
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJune 20, 2005
Last updated in NPPESOctober 22, 2007
Mailing address2001 Peachtree Rd Ne, Ste 645, Atlanta, GA 30309-1476

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1995 (31 years in practice)
Group practice Northside Urgent Care Holding Llc — 80 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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