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General NPI Number Information
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NPI Number | 1265530414
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Entity Type | Individual
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Provider Name | NATHANIEL ANDREW WILSON III PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 01/05/2021
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Provider Practice Location Address
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Address Line | 1201 W PEACHTREE ST NW STE 2300
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City | ATLANTA
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State | GA
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Zip | 30309-3453
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Country | US
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Telephone | 404-550-9981
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Fax | 404-719-4242
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Provider Business Mailing Address
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Address Line | PO BOX 7730
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City | ATLANTA
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State | GA
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Zip | 30357-0730
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Country | US
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Telephone | 404-550-9981
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Fax | 404-475-4880
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY002857
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License Number State | GA
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