Provider Demographics
NPI:1720026594
Name:WILKINSON, CRAIG MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:MICHAEL
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3330 PRESTON RIDGE RD
Mailing Address - Street 2:STE 300
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4509
Mailing Address - Country:US
Mailing Address - Phone:770-255-7423
Mailing Address - Fax:770-350-6637
Practice Address - Street 1:214 PERRY HWY
Practice Address - Street 2:
Practice Address - City:HAWKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31036-6748
Practice Address - Country:US
Practice Address - Phone:478-892-8585
Practice Address - Fax:478-892-8528
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0565062085R0001X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA577795376FMedicaid
GA577795376HMedicaid
GA92BBGBWOtherMEDICARE PROVIDER ID
GA577795376GMedicaid
GA577795376IMedicaid
GA577795376KMedicaid
GA577795376JMedicaid
GA577795376FMedicaid