MEDICARE: JOHN WILSON SR.

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	122300000X	Dentist	DN122429	GA

General Provider Information

NPI Number	:	1871164145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILSON SR.

Provider Business Mailing Address
First Line	:	442 AUMOND RD
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30909-3561
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4059 COLUMBIA RD
Second Line	:
City	:	MARTINEZ
State	:	GA
Zip	:	30907-2221
Country	:	US
Telephone Number	:	706-863-9445
Fax Number	:	706-863-7452

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

Provider Enumeration Date	:	07/07/2021
Last Update Date	:	04/05/2023

Similar Medicare Providers

1356297717 — SPARK WELLNESS LLC
Practice Location Address:

4007 COLUMBIA RD
MARTINEZ, GA
30907-2221

Practice Phone: 706-250-1151
Practice Fax:

1811957376 — STEVEN LAMAR WILSON D.M.D.
Practice Location Address:

4059 COLUMBIA RD
MARTINEZ, GA
30907-2221

Practice Phone: 706-863-9445
Practice Fax: 706-863-7452

1568511129 — GAY AUREA PIMENTEL CALUYA DPT
Practice Location Address:

761 KATYDID CT , MARTINEZ
MARTINEZ, CA
94553-2221

Practice Phone: 510-375-3626
Practice Fax:

1427764596 — BGD PSYCHOLOGICAL SERVICES INC
Practice Location Address:

745 KATYDID CT
MARTINEZ, CA
94553-2221

Practice Phone: 510-250-2805
Practice Fax:

1477314623 — SYDNEY SMITH
Practice Location Address:

4210 COLUMBIA RD BLDG 9
MARTINEZ, GA
30907-0401

Practice Phone: 706-842-5330
Practice Fax: 706-842-5340

1982819629 — MS. KIMBERLY M TAYLOR
Practice Location Address:

3712 EXECUTIVE CENTER DR
MARTINEZ, GA
30907-5095

Practice Phone: 706-825-7527
Practice Fax:

Directions to “ JOHN WILSON SR. ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.