Healthcare Provider Details

I. General information

NPI: 1316884810
Provider Name (Legal Business Name): GEORGE J WILSON AGNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 ALGONQUIN TRL
BROWNS MILLS NJ
08015-6206
US

IV. Provider business mailing address

310 ALGONQUIN TRL
BROWNS MILLS NJ
08015-6206
US

V. Phone/Fax

Practice location:
  • Phone: 856-883-1310
  • Fax:
Mailing address:
  • Phone: 856-883-1310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN693229
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: