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General NPI Number Information
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NPI Number | 1326664061
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Entity Type | Individual
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Provider Name | VALARIE D. WILSON DMD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2020
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 3155 ROYAL DR STE 125
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City | ALPHARETTA
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State | GA
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Zip | 30022-2477
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Country | US
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Telephone | 404-612-1867
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Fax |
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Provider Business Mailing Address
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Address Line | 565 OLD FRIAR TUCK LN
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-5236
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Country | US
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Telephone | 404-786-4207
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN011475
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN011475
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License Number State | GA
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