Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0000X | Internist - Cardiovascular Disease | 054294 | GA |
NPI | 1003093600 |
---|---|
Provider Name | Dr. Matthew J. Wilson |
First Address | Atlanta, GA 30328-4274 |
Second Address | Atlanta, GA 30328 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 14/09/2012 |