Healthcare Provider Details

I. General information

NPI: 1942205224
Provider Name (Legal Business Name): CHARLES INMAN WILMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 COLLIER RD NW SUITE 300
ATLANTA GA
30309-1709
US

IV. Provider business mailing address

275 COLLIER RD NW SUITE 300
ATLANTA GA
30309-1709
US

V. Phone/Fax

Practice location:
  • Phone: 404-605-2800
  • Fax: 404-351-5983
Mailing address:
  • Phone: 404-605-2800
  • Fax: 404-351-5983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number029394
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number029394
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: