Provider Demographics
NPI:1336525674
Name:WILKINSON, KYLE HENLEY (CPA)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:HENLEY
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:CPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:GA
Mailing Address - Zip Code:30650-2073
Mailing Address - Country:US
Mailing Address - Phone:706-738-1275
Mailing Address - Fax:706-438-1278
Practice Address - Street 1:1077 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-2073
Practice Address - Country:US
Practice Address - Phone:706-438-1275
Practice Address - Fax:706-438-1278
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA58-2223937207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine