Provider Demographics
NPI:1942620059
Name:WILSON, KATHERINE MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:MORGAN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5445 MERIDIAN MARK RD STE 380
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4755
Mailing Address - Country:US
Mailing Address - Phone:404-705-3100
Mailing Address - Fax:404-705-3040
Practice Address - Street 1:5445 MERIDIAN MARK RD STE 380
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4755
Practice Address - Country:US
Practice Address - Phone:404-705-3100
Practice Address - Fax:404-705-3040
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111331208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program