Provider Demographics
NPI:1497714331
Name:WILKIEMEYER, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:WILKIEMEYER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5115 NEW PEACHTREE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3326
Mailing Address - Country:US
Mailing Address - Phone:678-336-5951
Mailing Address - Fax:678-336-5955
Practice Address - Street 1:1100 JOHNSON FERRY RD
Practice Address - Street 2:BUILDING II SUITE 470
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1709
Practice Address - Country:US
Practice Address - Phone:404-255-4901
Practice Address - Fax:404-843-2447
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-02-26
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Provider Licenses
StateLicense IDTaxonomies
GA054699208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
H94906Medicare UPIN
02BDJBGMedicare ID - Type Unspecified