1053443358 NPI number — MRS. ADRIA H WILKES M.D.

Table of content: MRS. ADRIA H WILKES M.D. (NPI 1053443358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053443358 NPI number — MRS. ADRIA H WILKES M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILKES
Provider First Name:
ADRIA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILKES
Provider Other First Name:
ADRIA
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1053443358
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 WATERS AVE
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31404-6702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
912-355-2462
Provider Business Mailing Address Fax Number:
912-353-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4600 WATERS AVE
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31404-6702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-355-2462
Provider Business Practice Location Address Fax Number:
912-353-1836
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  058197 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 581102392 . This is a "TAX ID" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 058197 . This is a "LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 714163085C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




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