Lynette Rochelle Wilson-Phillips, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

038132 Issued in GA

Practice address

4112 E Ponce de Leon Ave
Clarkston, GA 30021-1817

Phone

(404) 296-7133

Fax

(404) 501-9744

NPI assigned

Apr 13, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lynette.wilson-phillips.1@9679.direct.athenahealth.com
• Direct secure messaging: lwilsonphillips4705@choa.gadirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stone Mountain, GA
  • NPI 1417011487

  GA

  Medicare reassignment NPD
• Kids-Doc-on-Wheels

  • Pediatrics Physician
  • Clarkston, GA
  • NPI 1497277404

  Pediatrics

  NPD (past) Authorized official
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Atlanta, GA
  • NPI 1811761448
  NPD
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Stone Mountain, GA
  • NPI 1255779468
  NPD (past)
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Clarkston, GA
  • NPI 1770286726
  NPD (past)
• Medcura Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Conyers, GA
  • NPI 1811333859
  NPD (past)

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

{
    "created_epoch": "1144886400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316390400000",
    "number": "1992769269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5268 SANDY SHORES CT",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300383957",
            "telephone_number": "404-405-6863",
            "fax_number": "404-501-9744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4112 E PONCE DE LEON AVE",
            "city": "CLARKSTON",
            "state": "GA",
            "postal_code": "300211817",
            "telephone_number": "404-296-7133",
            "fax_number": "404-501-9744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON-PHILLIPS",
        "first_name": "LYNETTE",
        "middle_name": "ROCHELLE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-13",
        "last_updated": "2011-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "038132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000681106C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000681106B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thu D. Vu, D.D.S.
• Dorothy A. O. White-Williams, M.D.
• Lauren Alicia White
• Matana Queen Williams, OTR/L
• Patricia Williams, LPC
• Annette N/a Wilson
• Akosua Lynique Yeboah, CNA
• Zak Pharmacy LLC.

• All providers in Clarkston, GA
• Pediatrics Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2011; 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.

Verify at the official NPI Registry.