Individual provider Active NPI

Katelyn Stahl Wilson, CAA

  • Anesthesiologist Assistant
  • Marietta, GA
National Provider Identifier
1164965349
Registry record updated Feb 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
8217 Issued in GA
Practice address
677 Church St NE
Marietta, GA 30060
Phone
(770) 794-0477
NPI assigned
Nov 21, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 92 SC
Anesthesiologist Assistant 367H00000X 8217 GA Primary

Addresses

Primary practice location

677 Church St NE
Marietta, GA 30060

Mailing address

PO Box 603484
Charlotte, NC 28260-3484
Phone (803) 765-1838

Other practice location 1

146 Bill Carruth Pkwy
Hiram, GA 30141-3749
Phone (770) 794-0477

Other practice location 2

303 Parkway Dr NE
Atlanta, GA 30312-1212
Phone (843) 343-3557

Other practice location 3

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Other practice location 4

8954 Hospital Dr
Douglasville, GA 30134-2272
Phone (770) 794-0477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170109003179 GA Practitioner - Anesthesiology Assistant 6901187715 Reassigns benefits to 2 organizations
I20230718002951 SC Practitioner - Anesthesiology Assistant 6901187715 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Trident Anesthesia Group LLCGroup PAC ID 5294631545, 121 clinicians

Practice addresses (Care Compare)

9330 Medical Plaza Dr
Charleston, SC 29406-9104
Phone (843) 797-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8217GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Coastal Anesthesia Associates, LLC CurrentSince Jun 9, 2025 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jun 6, 2023 Accepting new patients
Trident Anesthesia Group, LLC CurrentSince Jun 9, 2025 Accepting new patients
Piedmont Anesthesia Associates, L.L.C CurrentSince Oct 19, 2020 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jun 6, 2023 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Nov 20, 2018 Accepting new patients

Locations

1968 Ptree Rd NW
Atlanta, GA 30309
Phone (404) 605-2222

1800 Howell Mill Rd NW
Ste 250
Atlanta, GA 30318
Phone (404) 537-4910

1984 Peachtree Rd NW
Ste 515
Atlanta, GA 30309
Phone (404) 351-1754

303 Parkway Dr NE
Atlanta, GA 30312
Phone (404) 265-4000

3950 Austell Rd
Austell, GA 30106
Phone (770) 732-3752

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

677 Church St NE
Marietta, GA 30060
Phone (770) 793-5435

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

423 Barony St
Moncks Corner, SC 29461

9330 Medical Plaza Dr
North Charleston, SC 29406
Phone (843) 554-6366

9313 Medical Plaza Dr
Ste 102
North Charleston, SC 29406
Phone (843) 572-1228

295 Midland Pkwy
Summerville, SC 29485
Phone (843) 554-6366

130 Edge St
Summerville, SC 29486
Phone (843) 628-5816

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771286400000",
    "number": "1164965349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603484",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603484",
            "telephone_number": "803-765-1838",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 CHURCH ST NE",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-794-0477"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "146 Bill Carruth Pkwy",
            "address_purpose": "LOCATION",
            "city": "Hiram",
            "state": "GA",
            "postal_code": "301413749",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "303 Parkway Dr NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303121212",
            "country_code": "US",
            "telephone_number": "843-343-3557",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "fax_number": "843-402-1833",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8954 Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Douglasville",
            "state": "GA",
            "postal_code": "301342272",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KATELYN",
        "middle_name": "STAHL",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-21",
        "last_updated": "2026-02-17",
        "certification_date": "2026-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "SC",
            "license": "92",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "8217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.