Individual
DR. KARISSA KING WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
127 TELFAIR ST, AUGUSTA, GA 30901-2590
(706) 922-0600
(706) 922-0604
Mailing address
PO BOX 2344, AUGUSTA, GA 30903-2344
(706) 922-0600
(706) 922-0604
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
066106
GA
207Q00000X
Family Medicine Physician
MD30829
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003112479A
—
GA
Enumeration date
06/12/2008
Last updated
08/29/2012
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