Healthcare Provider Details

I. General information

NPI: 1841836392
Provider Name (Legal Business Name): KIZZY WILKINS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIZZY WILKINS APRN

II. Dates (important events)

Enumeration Date: 11/20/2019
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MEDICAL PARK DR STE 2200
AUSTELL GA
30106-1110
US

IV. Provider business mailing address

5447 DIVIDEND DR
LITHONIA GA
30058
US

V. Phone/Fax

Practice location:
  • Phone: 770-941-7741
  • Fax:
Mailing address:
  • Phone: 770-322-8881
  • Fax: 770-322-8886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP253340
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: