Provider Demographics
NPI:1114300977
Name:DEPEAU-WILSON, DANIELLE ASHLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ASHLEY
Last Name:DEPEAU-WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:ASHLEY
Other - Last Name:DEPEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6335 HOSPITAL PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1550
Mailing Address - Country:US
Mailing Address - Phone:404-778-8240
Mailing Address - Fax:
Practice Address - Street 1:6335 HOSPITAL PKWY STE 110
Practice Address - Street 2:
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-1550
Practice Address - Country:US
Practice Address - Phone:404-778-8240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-29
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018812363AM0700X
GA11006363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical