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

Marysa P Wallace, AGNP-C

Individual provider Nurse Practitioner · NPI 1932989357

Marysa P Wallace, AGNP-C is a Nurse Practitioner in Fayetteville, Georgia. Graduated from Mercer University School of Medicine in 2016, 10 years ago. Practices with Nsh Cancer Institute Professional Services G LLC, a 116-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Georgia.

Years since qualifying
10
Trained at
Mercer University School of Medicine
Licensed in
GA
In the registry since
2023

Practice location Address checks out

132 Old Norton Rd Ste 200
Fayetteville, GA 30215-4873
Phone: (678) 817-1117
Fax: (678) 817-0823
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence RN259981 (GA)

Record details

NPI number1932989357
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGNP-C
Sole proprietorNo
NPI enumeratedOctober 3, 2023
Last updated in NPPESAugust 14, 2024
Certification dateAugust 14, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolMERCER UNIVERSITY SCHOOL OF MEDICINE
Graduated 2016 (10 years in practice)
Group practice Nsh Cancer Institute Professional Services G Llc — 116 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fayetteville