Individual provider Active NPI

Keisha Lynn Wilkerson, MSPH

  • Anesthesiologist Assistant
  • Atlanta, GA
National Provider Identifier
1336451889
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
5927 Issued in GA
Practice address
1364 Clifton Rd NE
Atlanta, GA 30322
Phone
(404) 778-5778
NPI assigned
Jul 12, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

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
Anesthesiologist Assistant 367H00000X 5927 GA Primary

Addresses

Primary practice location

1364 Clifton Rd NE
Atlanta, GA 30322

Mailing address

1364 Clifton Rd NE
Atlanta, GA 30322-1059
Phone (404) 778-5778

Other practice location 1

3950 Austell Rd
Austell, GA 30106-1121
Phone (770) 702-1806

Other practice location 2

677 Church St NE
Marietta, GA 30060-1101
Phone (770) 794-0477

Other practice location 3

745 Poplar Rd
Newnan, GA 30265-1618
Phone (770) 400-1000

Other practice location 4

775 Poplar Rd Ste Ll20
Newnan, GA 30265-8306
Phone (770) 253-1912

Other practice location 5

1255 Highway 54 W
Fayetteville, GA 30214-4526
Phone (404) 351-1745

Other practice location 6

1968 Peachtree Rd NW
Atlanta, GA 30309-1281
Phone (678) 216-0771

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110104001089 GA Practitioner - Anesthesiology Assistant 2769671924 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Emory University School of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Anesthesia LLCGroup PAC ID 2163837972, 555 clinicians

Practice addresses (Care Compare)

1255 Hwy 54 W
Fayetteville, GA 30214
Phone (770) 719-7000

Hospital & facility affiliations

  • Piedmont Hospital, Inc Hospital, Atlanta, GA, CCN 110083

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5927GAMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Anesthesia of Georgia LLC Anesthesiologist Assistant CurrentSince May 16, 2018 Accepting new patients
Piedmont Anesthesia Associates, L.L.C CurrentSince Jun 8, 2021 Accepting new patients
Mak Anesthesia Holdings LLC CurrentSince Jun 1, 2018 Accepting new patients
Piedmont Anesthesia LLC CurrentSince May 1, 2025 Accepting new patients
The Emory Clinic Inc CurrentSince Oct 1, 2010 Accepting new patients

Locations

1365 Clifton Rd NE
Atlanta, GA 30322
Phone (404) 778-7525

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

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

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

1255 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-6911

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

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

745 Poplar Rd
Newnan, GA 30265
Phone (404) 478-8785

775 Poplar Rd
Ste LL20
Newnan, GA 30265
Phone (770) 253-1912

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

Organizations & group practices 5

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": "1278892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1336451889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303221059",
            "telephone_number": "404-778-5778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1364 CLIFTON RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "30322",
            "telephone_number": "404-778-5778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3950 Austell Rd",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301061121",
            "country_code": "US",
            "telephone_number": "770-702-1806",
            "fax_number": "770-693-0810",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "677 Church St NE",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300601101",
            "country_code": "US",
            "telephone_number": "770-794-0477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "745 Poplar Rd",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302651618",
            "country_code": "US",
            "telephone_number": "770-400-1000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "775 Poplar Rd Ste Ll20",
            "address_purpose": "LOCATION",
            "city": "Newnan",
            "state": "GA",
            "postal_code": "302658306",
            "country_code": "US",
            "telephone_number": "770-253-1912",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1255 Highway 54 W",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "GA",
            "postal_code": "302144526",
            "country_code": "US",
            "telephone_number": "404-351-1745",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1968 Peachtree Rd NW",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303091281",
            "country_code": "US",
            "telephone_number": "678-216-0771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "KEISHA",
        "middle_name": "LYNN",
        "credential": "MSPH",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-12",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "GA",
            "license": "5927",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2023; 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.