Healthcare Provider Details

I. General information

NPI: 1518383959
Provider Name (Legal Business Name): DANA M WILSON DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 ROCKBRIDGE ROAD, SW SUITE F
STONE MTN GA
30087
US

IV. Provider business mailing address

1310 ROCKBRIDGE RD STE F
STONE MOUNTAIN GA
30087-3163
US

V. Phone/Fax

Practice location:
  • Phone: 770-864-5538
  • Fax: 404-393-4038
Mailing address:
  • Phone: 770-864-5538
  • Fax: 404-393-4038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN220371
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: