Provider Demographics
NPI:1063593549
Name:WILKERSON, DONNA MARIA (DDS)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:MARIA
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3365 PIEDMONT RD NE STE 1100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1708
Mailing Address - Country:US
Mailing Address - Phone:404-237-3070
Mailing Address - Fax:
Practice Address - Street 1:600 W PEACHTREE ST NW
Practice Address - Street 2:SUITE 750
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3607
Practice Address - Country:US
Practice Address - Phone:404-876-7200
Practice Address - Fax:404-876-2660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA110631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice