Healthcare Provider Details

I. General information

NPI: 1437673266
Provider Name (Legal Business Name): AMBER A WILSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2017
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 1ST ST STE 410
MACON GA
31201-8306
US

IV. Provider business mailing address

119 ROBERTS RD
KATHLEEN GA
31047-2717
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-7068
  • Fax: 478-741-1354
Mailing address:
  • Phone: 478-952-0974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP216840
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN216840
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP216840
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: