Kristin Nicole Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN122747 Issued in GA

Practice address

4070 Lavista Rd Ste 102
Tucker, GA 30084-5228

Phone

(770) 225-0723

Fax

(770) 491-0037

NPI assigned

Jun 28, 2021

Last updated

Aug 15, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1624838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1346810900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3897 RIVER RIDGE CT",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300346902",
            "telephone_number": "404-906-1552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAVISTA RD STE 102",
            "city": "TUCKER",
            "state": "GA",
            "postal_code": "300845228",
            "telephone_number": "770-225-0723",
            "fax_number": "770-491-0037"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1301 Punchbowl St",
            "address_purpose": "LOCATION",
            "city": "Honolulu",
            "state": "HI",
            "postal_code": "968132499",
            "country_code": "US",
            "telephone_number": "808-691-4292",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KRISTIN",
        "middle_name": "NICOLE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-28",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "HI",
            "license": "DT-2911-0",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN122747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tameica Williams, LCSW
• Tarrah B. Williams, PHARM.D.
• Tatiana Williams
• Jacqueline D Wilson, PT
• Jerry Dewayne Wilson, PA-C
• Patricia Wilson
• Rosemarie Wilson, CASE MANAGER
• Samantha Elizabeth Wilson, MASSAGE THERAPIST
• Jeremy Dewayne Winbush, COTA
• Monique Wischusen

• General Practice Dentistry in Tucker, GA
• Providers in Tucker, GA by specialty
• General Practice Dentistry in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.