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General NPI Number Information
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NPI Number | 1710821988
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Entity Type | Individual
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Provider Name | MATTHEW ROBERT WILSON PHARMD
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Gender | Male
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Dates
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Enumeration Date | 04/16/2026
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Last Update Date | 04/16/2026
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Provider Practice Location Address
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Address Line | 595 PIEDMONT AVE NE STE 100
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City | ATLANTA
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State | GA
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Zip | 30308-2480
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Country | US
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Telephone | 404-685-9665
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Fax |
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Provider Business Mailing Address
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Address Line | 2482 CEDAR KNOLL DR
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City | APOPKA
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State | FL
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Zip | 32712-6425
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Country | US
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Telephone | 770-715-6106
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023382
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License Number State | GA
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