Individual
KISHA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1405 ADAMS LAKE BLVD SE, ATLANTA, GA 30339-3389
(614) 352-9672
Mailing address
1405 ADAMS LAKE BLVD SE, ATLANTA, GA 30339-3389
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
001609
GA
Other
Enumeration date
04/14/2008
Last updated
04/18/2008
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