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General NPI Number Information
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NPI Number | 1336358050
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Entity Type | Individual
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Provider Name | KELITA WILEY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 07/30/2010
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Provider Practice Location Address
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Address Line | 920 MADISON AVE SUITE C50
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City | MEMPHIS
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State | TN
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Zip | 38103-3438
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Country | US
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Telephone | 901-465-3203
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Fax |
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Provider Business Mailing Address
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Address Line | 5260 SAVANNAH TER
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City | STONE MOUNTAIN
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State | GA
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Zip | 30083-2258
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 062631
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License Number State | GA
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