Active NPI
Ann Wilson
- General Practice Physician
- Stockbridge, GA
National Provider Identifier
1063317907
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 244167
- Practice address
- 15 Moore Dr
Stockbridge, GA 30281-2501 - Phone
- (419) 377-1109
- NPI assigned
- Oct 12, 2026
- Last updated
- Oct 12, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 244167 | SC | Primary |
Addresses
Primary practice location
15 Moore Dr
Stockbridge, GA 30281-2501
Mailing address
15 Moore Dr
Stockbridge, GA 30281-2501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1791763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1791763200000",
"number": "1063317907",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 MOORE DR",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302812501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 MOORE DR",
"city": "STOCKBRIDGE",
"state": "GA",
"postal_code": "302812501",
"telephone_number": "419-377-1109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "ANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-10-12",
"last_updated": "2026-10-12",
"certification_date": "2026-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "SC",
"license": "244167",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockbridge, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.