| Doctor Name: | HERBERT WILSON |
| NPI Number: | 1023481199 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | RN000000 |
| Business Practice Address: | 2200 Highway 155 N Mcdonough, GA - 302524846 |
| Business Phone Number: | 6784900341 |
| Business Fax Number: | 6784900349 |
| Mailing Address: | 2200 Highway 155 N, MCDONOUGH |
| State: | GA |
| Postal Code: | 302524846 |
| Phone Number: | 6784900341 |
| Fax Number: | 6784900349 |
| NPI Enumeration Date: | 11/11/2015 |
| NPI Last Update Date: | 11/11/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | RN000000 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |