Provider Demographics
NPI:1508310509
Name:WILKINSON, ALYSHA RAVEN (DC)
Entity Type:Individual
Prefix:DR
First Name:ALYSHA
Middle Name:RAVEN
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 GARRISON PLANTATION DR SE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-3145
Mailing Address - Country:US
Mailing Address - Phone:321-615-4655
Mailing Address - Fax:
Practice Address - Street 1:244 14TH ST NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-7711
Practice Address - Country:US
Practice Address - Phone:404-876-0550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR009743111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor