Active NPI
Jessica Santrice Wilson, DO
- Allergy & Immunology Physician
- Athens, GA
National Provider Identifier
1760004295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Allergy & Immunology Physician
- License
- 114686
- Practice address
- 330 Hawthorne LN
Athens, GA 30606-2152 - Phone
- (706) 613-8500
- Fax
- (706) 613-8844
- NPI assigned
- May 6, 2020
- 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 |
|---|---|---|---|---|
| Allergy & Immunology Physician | 207K00000X | 114686 | GA | Primary |
Addresses
Primary practice location
330 Hawthorne LN
Athens, GA 30606-2152
Mailing address
PO Box 603725
Charlotte, NC 28260-3725
Phone (828) 575-2625
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX, OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200813003363 | TX | Order and Referring Only - Internal Medicine | 5395161863 | |
| I20240725002781 | OH | Order and Referring Only - Allergy/Immunology | 5395161863 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588723200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1789084800000",
"number": "1760004295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 603725",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282603725",
"telephone_number": "828-575-2625",
"fax_number": "828-350-2174"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "330 HAWTHORNE LN",
"city": "ATHENS",
"state": "GA",
"postal_code": "306062152",
"telephone_number": "706-613-8500",
"fax_number": "706-613-8844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "JESSICA",
"middle_name": "SANTRICE",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-05-06",
"last_updated": "2026-09-11",
"certification_date": "2026-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "207K00000X",
"taxonomy_group": "",
"desc": "Allergy & Immunology",
"state": "GA",
"license": "114686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Athens, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.