Healthcare Provider Details

I. General information

NPI: 1508191776
Provider Name (Legal Business Name): KATHLEEN ADAMS WILMER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN RYAN ADAMS RN

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 04/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 PIEDMONT AVE NE SUITE 100
ATLANTA GA
30308-2478
US

IV. Provider business mailing address

595 PIEDMONT AVE NE SUITE 100
ATLANTA GA
30308-2478
US

V. Phone/Fax

Practice location:
  • Phone: 866-825-3227
  • Fax:
Mailing address:
  • Phone: 866-825-3227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN199241
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN199241
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: