Provider Demographics
NPI:1669780185
Name:WILKINSON, ADAM CARLISLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CARLISLE
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3738
Mailing Address - Country:US
Mailing Address - Phone:770-386-6300
Mailing Address - Fax:770-382-0791
Practice Address - Street 1:695 HENDERSON DR
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3738
Practice Address - Country:US
Practice Address - Phone:770-386-6300
Practice Address - Fax:770-382-0791
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT010085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist