MEDICARE: DR. DONNA MARIA WILKERSON D.D.S

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	1223G0001X	General Practice Dentistry	11063	GA

General Provider Information

NPI Number	:	1063593549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DONNA MARIA WILKERSON D.D.S

Provider Business Mailing Address
First Line	:	3365 PIEDMONT RD NE STE 1100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30305-1708
Country	:	US
Telephone Number	:	404-237-3070
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W PEACHTREE ST NW
Second Line	:	SUITE 750
City	:	ATLANTA
State	:	GA
Zip	:	30308-3607
Country	:	US
Telephone Number	:	404-876-7200
Fax Number	:	404-876-2660

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	02/21/2022

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