MEDICARE: DR. ROBERT W. WILKESON D.O.

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	047284	GA

General Provider Information

NPI Number	:	1790713246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W. WILKESON D.O.

Provider Business Mailing Address
First Line	:	8856 GREENLEAF DR
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-1288
Country	:	US
Telephone Number	:	706-568-1909
Fax Number	:

Provider Business Practice Location Address
First Line	:	7950 MARTIN LOOP
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-5647
Country	:	US
Telephone Number	:	706-544-1711
Fax Number	:

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	07/08/2007

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