Individual provider Active NPI

Leslie Andrew Wilkerson, M.D.

  • Gynecology Physician
  • Gainesville, GA
National Provider Identifier
1457348120
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gynecology PhysicianTaxonomy code 207VG0400X
License
022491 Issued in GA
Practice address
2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone
(770) 534-3616
Fax
(770) 287-3477
NPI assigned
Sep 28, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 022491 GA Primary

Addresses

Primary practice location

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401

Mailing address

2406 Lighthouse Manor Dr
Gainesville, GA 30501-7401
Phone (770) 534-3616

Other identifiers 2

IdentifierTypeStateIssuer
00217544AMedicaidGA
732949OtherGABLUE CROSS/BLUE SHIELD

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
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
022491GAMDGynecology Physician

NPI Registry JSON

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

{
    "created_epoch": "1127865600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1457348120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2406 LIGHTHOUSE MANOR DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017401",
            "telephone_number": "770-534-3616",
            "fax_number": "770-287-3477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2406 LIGHTHOUSE MANOR DR",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017401",
            "telephone_number": "770-534-3616",
            "fax_number": "770-287-3477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "LESLIE",
        "middle_name": "ANDREW",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-28",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "GA",
            "license": "022491",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00217544A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "732949",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gainesville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.