MEDICARE: DR. GEORGE R WILMOT III M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	004608	GA

General Provider Information

NPI Number	:	1174531313
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE R WILMOT III M.D., PH.D.

Provider Business Mailing Address
First Line	:	1450 COUNTRY LAKE DR SW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-6762
Country	:	US
Telephone Number	:	770-381-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-4021
Country	:	US
Telephone Number	:	404-728-4895
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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