MEDICARE: DR. DARIN KEITH WILSON MD

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	208M00000X	Hospitalist Physician	069671	GA
2	207R00000X	Internal Medicine Physician	069671	GA

General Provider Information

NPI Number	:	1497755706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARIN KEITH WILSON MD

Provider Business Mailing Address
First Line	:	35 COLLIER RD NW
Second Line	:	SUITE 635
City	:	ATLANTA
State	:	GA
Zip	:	30309-1613
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 COLLIER RD NW
Second Line	:	SUITE 635
City	:	ATLANTA
State	:	GA
Zip	:	30309-1613
Country	:	US
Telephone Number	:	404-367-3014
Fax Number	:

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

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	03/22/2017

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