MEDICARE: KISHA WILSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	001609	GA

General Provider Information

NPI Number	:	1053585703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KISHA WILSON

Provider Business Mailing Address
First Line	:	1405 ADAMS LAKE BLVD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3389
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1405 ADAMS LAKE BLVD SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30339-3389
Country	:	US
Telephone Number	:	614-352-9672
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2008
Last Update Date	:	04/18/2008

Similar Medicare Providers

1659920940 — NEW GENERATION HEALTH CARE INC
Practice Location Address:

1423 ADAMS LAKE BLVD SE
ATLANTA, GA
30339-3389

Practice Phone: 404-916-9941
Practice Fax:

1023086667 — DR. CHRISTINA NICOLE NEROS D.C., M.S.
Practice Location Address:

1756 CENTURY BLVD NE STE A
ATLANTA, GA
30345-3389

Practice Phone: 404-638-6653
Practice Fax: 888-671-5236

1225747561 — SADE STOKES LCPC
Practice Location Address:

1756 CENTURY BLVD NE STE B
ATLANTA, GA
30345-3389

Practice Phone: 312-248-2531
Practice Fax:

1003775818 — JUST NEW MATERIAL LLC
Practice Location Address:

1756 CENTURY BLVD NE STE B
ATLANTA, GA
30345-3389

Practice Phone: 312-248-2531
Practice Fax:

1578410825 — WISDOMS HOUSE INC
Practice Location Address:

400 GALLERIA PKWY SE
ATLANTA, GA
30339-5980

Practice Phone: 678-534-5887
Practice Fax:

1508714296 — UPSTREAM ABA GEORGIA LLC
Practice Location Address:

2727 PACES FERRY RD SE STE 750
ATLANTA, GA
30339-4053

Practice Phone: 706-389-4307
Practice Fax:

Directions to “ KISHA WILSON ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.