Kenleeanne Hass Wilson, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN123157 Issued in GA

Practice address

114 Calumet Center Rd
Lagrange, GA 30241-6703

Phone

(706) 882-1888

NPI assigned

Jul 19, 2023

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Annie Wilson Other name

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": "1689724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689724800000",
    "number": "1760162366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 CALUMET CENTER RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302416703",
            "telephone_number": "706-882-1888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 CALUMET CENTER RD",
            "city": "LAGRANGE",
            "state": "GA",
            "postal_code": "302416703",
            "telephone_number": "706-882-1888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Main St",
            "address_purpose": "LOCATION",
            "city": "Hogansville",
            "state": "GA",
            "postal_code": "302301507",
            "country_code": "US",
            "telephone_number": "706-637-6125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KENLEEANNE",
        "middle_name": "HASS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-07-19",
        "last_updated": "2023-07-19",
        "certification_date": "2023-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "GA",
            "license": "DN123157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNIE",
            "last_name": "WILSON",
            "credential": "DMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Celena Michelle Williams, PT
• Mary Katherine Williams, CFNP
• Sharonda M. Williams, MSW
• Eddie Q Willis, DMD
• Linda Willoughby, RPH.
• Robin Wilson, LPN
• Joni Lee Winter, FNP
• Deena Renae Wise, D.O.
• Wolf Specific, Inc
• Matthew Tyler Wolfertz, D.C.

• General Practice Dentistry in Lagrange, GA
• Providers in Lagrange, 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 Jul 19, 2023; 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.