Individual
KERRI L WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
12192 AUGUSTA ROAD, LAVONIA, GA 30553-1209
(706) 356-1072
(706) 356-1457
Mailing address
12192 AUGUSTA ROAD, LAVONIA, GA 30553-1209
(706) 356-1072
(706) 356-1457
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
192545
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
669649351A
—
GA
Enumeration date
08/12/2010
Last updated
05/05/2011
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