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General NPI Number Information
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NPI Number | 1467919001
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Entity Type | Individual
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Provider Name | NATHANIEL ROBERT WILSON MD
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Gender | Male
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Dates
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Enumeration Date | 03/01/2019
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 1365 CLIFTON RD NE BLDG C
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 618-975-0382
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Fax |
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Provider Business Mailing Address
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Address Line | 1365 CLIFTON RD NE BLDG C
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City | ATLANTA
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State | GA
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Zip | 30322-1013
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Country | US
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Telephone | 618-975-0382
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | S8403
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 103955
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License Number State | GA
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