Active NPI
Suzette Karen Wilson, CMA,PCT,LMT
- Specialist
- Kennesaw, GA
National Provider Identifier
1407170475
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MT005239
- Practice address
- 4172 Shiloh Ridge TRL NW
Kennesaw, GA 30144-2160 - Phone
- (770) 865-9886
- NPI assigned
- Mar 19, 2010
- Last updated
- Mar 19, 2010
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Specialist | 174400000X | MT005239 | GA | Primary |
Addresses
Primary practice location
4172 Shiloh Ridge TRL NW
Kennesaw, GA 30144-2160
Mailing address
4172 Shiloh Ridge TRL NW
Kennesaw, GA 30144-2160
Phone (770) 865-9886
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)
- Not enrolled
- Credentials
- Certified Medical Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT005239 | GA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1268956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1268956800000",
"number": "1407170475",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4172 SHILOH RIDGE TRL NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301442160",
"telephone_number": "770-865-9886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4172 SHILOH RIDGE TRL NW",
"city": "KENNESAW",
"state": "GA",
"postal_code": "301442160",
"telephone_number": "770-865-9886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "SUZETTE",
"middle_name": "KAREN",
"name_prefix": "Ms.",
"credential": "CMA,PCT,LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-03-19",
"last_updated": "2010-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "GA",
"license": "MT005239",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kennesaw, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 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.