=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447973011
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY CAPERS ELDER WICKER PA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2022
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5665 NEW NORTHSIDE DR STE 220
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30328-5831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-260-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 691 14TH ST NW UNIT 511
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30318-5620
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-260-0199
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 12107
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------