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NPI Code Detail

MEDICARE: DR. NATHANIEL ANDREW WILSON III PSY.D.

MEDICARE: DR. NATHANIEL ANDREW WILSON III PSY.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
1103TC0700XClinical PsychologistPSY002857GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265530414
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATHANIEL ANDREW WILSON III PSY.D.
Provider Business Mailing Address
First Line : PO BOX 7730
Second Line :
City : ATLANTA
State : GA
Zip : 30357-0730
Country : US
Telephone Number : 404-550-9981
Fax Number : 404-475-4880
Provider Business Practice Location Address
First Line : 1201 W PEACHTREE ST NW STE 2300
Second Line :
City : ATLANTA
State : GA
Zip : 30309-3453
Country : US
Telephone Number : 404-550-9981
Fax Number : 404-719-4242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 01/05/2021

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