Active NPI
Kelita Wiley, M.D.
- Psychiatry Physician
- Memphis, TN
National Provider Identifier
1336358050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 062631
- Practice address
- 920 Madison Ave
Suite C50
Memphis, TN 38103-3438 - Phone
- (901) 465-3203
- NPI assigned
- May 21, 2007
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 062631 | GA | Primary |
Addresses
Primary practice location
920 Madison Ave
Suite C50
Memphis, TN 38103-3438
Mailing address
5260 Savannah Ter
Stone Mountain, GA 30083-2258
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 062631 | GA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179705600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280448000000",
"number": "1336358050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5260 SAVANNAH TER",
"city": "STONE MOUNTAIN",
"state": "GA",
"postal_code": "300832258"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "920 MADISON AVE",
"address_2": "SUITE C50",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381033438",
"telephone_number": "901-465-3203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILEY",
"first_name": "KELITA",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-21",
"last_updated": "2010-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "GA",
"license": "062631",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.