Provider Demographics
NPI:1861238586
Name:WILSON, JOHANNA DAISY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:DAISY
Last Name:WILSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:830 JARDIN CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4608
Mailing Address - Country:US
Mailing Address - Phone:706-818-4874
Mailing Address - Fax:
Practice Address - Street 1:12315 CRABAPPLE RD STE 108
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6330
Practice Address - Country:US
Practice Address - Phone:678-254-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical