Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Gisele Wogbo

Individual provider Family Medicine Physician · NPI 1063156636

Gisele Wogbo is a Family Practice in Kennesaw, Georgia. Qualified in 2009, 17 years ago. Practices with The Southeast Permanente Medical Group, a 826-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
17
Licensed in
GA
In the registry since
2022

Practice location Address checks out

750 Townpark Ln NW
Kennesaw, GA 30144-5579
Phone: (404) 365-0966
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 104254 (GA)

Record details

NPI number1063156636
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedApril 20, 2022
Last updated in NPPESSeptember 16, 2025
Certification dateSeptember 16, 2025
Mailing address750 Townpark Ln Nw, Kennesaw, GA 30144-5579

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2009 (17 years in practice)
Group practice The Southeast Permanente Medical Group — 826 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Kennesaw