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General NPI Number Information
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NPI Number | 1609392141
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Entity Type | Individual
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Provider Name | DR. JOHN WESLEY WILCOX II
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Gender | Male
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Dates
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Enumeration Date | 08/16/2017
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Last Update Date | 08/16/2017
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Provider Practice Location Address
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Address Line | 4999 PRESTLEY MILL RD
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-1463
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Country | US
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Telephone | 678-383-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 PRESTON LANDING CIR APT 305
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City | LITHIA SPRINGS
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State | GA
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Zip | 30122-6848
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Country | US
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Telephone |
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | PT012591
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License Number State | GA
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