MEDICARE: SARAH JO WILSON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	87686	GA

General Provider Information

NPI Number	:	1588041099
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH JO WILSON MD

Provider Business Mailing Address
First Line	:	112 WILSHIRE VILLAGE DR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3138
Country	:	US
Telephone Number	:	770-676-3376
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 WILSHIRE VILLAGE DR
Second Line	:
City	:	PEACHTREE CITY
State	:	GA
Zip	:	30269-3138
Country	:	US
Telephone Number	:	770-676-3376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	04/08/2026

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