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General NPI Number Information
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NPI Number | 1386727006
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Entity Type | Individual
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Provider Name | NATHAN A. WILSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 06/08/2020
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Provider Practice Location Address
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Address Line | 3485 MIKE PADGETT HWY
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City | AUGUSTA
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State | GA
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Zip | 30906-3815
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Country | US
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Telephone | 706-771-7843
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Fax |
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Provider Business Mailing Address
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Address Line | 6531 RIVER BLUFF TRL
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City | MARTINEZ
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State | GA
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Zip | 30907-3317
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Country | US
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Telephone | 706-831-5834
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 057203
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License Number State | GA
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